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Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of _
Division of Safety and Buildings;
in accordance with Comm 85, Wis. Adm. Code 1
County ~ - ~ Y- ~ t
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must
include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D.
percent slope, scale or dimensions, north arrow, and iocation and distance to nearest road. 1 J V r;
Please print all information. Reviewed t Date
2ov S
Personal information you provide m cy Law, s. 15.04 {t) {m)).
Property Owner S REC-FIVED Property Location
ey- GovL Lot 114 w 114 S( T Z C( N RE (or)®
Property Owner's Mailing Address 2 3 2604 Lot # Block # Subd. Name or CS M
6
City State 2 it) cool. ci;f ~(y~itj et ❑ City ❑ Village .Town Nearest Road
0 ING OFFICE II r-~
t-C T L COI.
New Construction Use: Residential) Number of bedrooms 3=` Code derived design flow rate GPD
❑ Replacement I ❑ Public or commercial - Describe:
Parent material __BUt-_~- Flood Plain elevation if applicable _-_U / ft•
General comments 60
and recommendations:
Boring # Boring Q~/ q _ .
In.
Ground surface elev. -0 ft. Depth to limiting factor _12q
Pit Soli Application Rate
III
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fft
in. Munsell Qu. Sz..Cont. Color Gr. Sz. Sh. `Eff#1 'Eff#2
C)_2 its r612 _S ZrroLk rnf ~ C I
Z 00-I2; y I4 L Zm C,S - ,
3 I3-fZq 10 y life S OS ffl I _ ._7 (.2-
Boling
,l
a Boring # lam. Pit Ground surface elev. 61 -ft. Depth to limiting factor V in.
- Sol Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDKf
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff#1 'Eff#2
-I I LO r 312 i I 2 rn5b r~n~r c S
2 11-2 s0 r~k1_3 Sict 2msbK
3 2lo-1z to r4 ko 0s t - _ 12
` Effluent #1 = BOD > 30:!i 220 mg/L and TSS >30 < 150 mg/L ` Effluent #2 = BOD < 30 mg/L. and TSS < 30 mg/L
CST Name (Please Print) Signature T N m
-l ~
.E
Address Date Evaluation Conducted Telephone Number
• _
Property Owner Parcel ID Page of
Boring # ❑ Boring u
Pit Ground surface elev.q , ga ft. Depth to 4mrtmg tact°r in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots •Eff#GPDIft'Eff#2
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh.
(~-1 0 312- - S C I 2msbk rYr 5 I v _ 5
2 11'2$ la r I3 Si cI 2mkr cS - y
3 2'3 - II 4~/ 5 059 ry-)
:Boring
❑ Boring # factor
❑ Pit Ground,surface elev. ft. Depth to limiting in.
Soil A lication Rate
Horizon Depth Dominant Color Redo. Description Texture Structure Consistence Boundary Roots GPDff
In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
F-1 Boring
Boring # Ground surface elev. ft. Depth to limiting factor in.
❑ Pit Sod lication Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDlftz
'Eff#1 'Eff#2
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. I
' Effluent #1 = BODS > 30 < 220 mglL and TSS >30 < 150 mglL ' Effluent 42 = BOD5 < 30 mglL and TSS < 30 mg/L
I
The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or
need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777.
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S B D-8330 (R.07/00)
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1 ~
` PAGE ~OF
NAME: e LOT#,H-LEGAL DESCRIPTIONSF.? /4t)LJ/4,S I I TZ--lN,R,_aE(or)jo
r
SCALE: 1"= yo
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00 ELEVATION: t n0 • 0
~oP o Qvc, ~•'dr _
BM 1 DESCRIPTION:
Q
s
BM 2 ELEVATION: Sec
BM 2 DESCRIPTION: 40 ouch? _
SYSTEM ELEVATION: O
SYSTEM TYPE: G n u e of dv 0.
• L~~lo' .Uvi~h ~o~ 1 'tee
9q ao 3
1~I
Q_~ dMz
SIGNATURE: DATE: y ~-G 7
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