HomeMy WebLinkAbout020-1402-05-000
Department of Commerce SOIL EVALUATION REPORT of 3
a/ibsoortstrt Page
Divisionof Safety and Buildings
in accordance with Comm 85, Wis. Adm. Code
County
0; X
Attach complete site plan on paper not less than 81/2 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 location and distance to nearest road. 02 Q - O / ~02
Please print all information. by Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). i I Q / Q
Property Owner Property Location
Qlthora OL34 Govt. Lot $ L 1/4 S F 1/4 S / / T Z9 N R /-r E (or) 10
Property Owner's Mailing Address Lot # Block # Subd. Name or CSMff
135 e -Tra 5 M IS-I View
City State Zip Code Phone Number 0 City ❑ Village EgTown Nearest Road
quds6n L01 1540%jo 9'.P o n -1-A el n /a
qj New Construction Use: [2 Residential / Number of bedrooms - Y_ Code derived design flow rate %5-0O G GPD
❑ Replacement ❑ Public or commercial - Describe: 4
Parent material G U a 5 Flood Plain elevation if applicable
General comments C~~ S Ft M Ql -e V . Q /o. Go W-e- Q (o .10
and recommendations: Li '.i t__...
5Te-M CA-iUkJp1 L ?E- //✓STixl'L two D~ ~/U YW 1-. Ai2
/ ~ ~h ~ ~;C;UfI?Y
t Boring# ❑ Boring 7,C7uitlCaGi F)C
t pit Ground surface elev. /0/, ft. Depth to limiting factor in.
t lion Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Bou % R?qt$ PDM
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff# I "Eff#2
0-I$ l0 l2 51 mfr c 5 IF
2 _~}Z l U Y 3 '50 2nr-Ak .5
~ZrLt A, -7 Z
Boring # Boring
I L--I ® Pit Ground surface elev. ft. Depth to limiting factor 20 in. soil tion Rate
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
1 -o-lb 'r3 1Z - l ~5 ( v9 5 -8
/D r4 3 s%~ k _ 5 8
A-b 42>t 3 /o rL64
rf6~ a~-
' Effluent #1 ='130D, > 30 < 220 mg/L and TSS >30 < 150 mg/L " Effluent #2 = BOD < 30 mg/L and TSS < 30 mglL
CST Name (Please Print) Signature CST Number
h Z
Address Date Evaluation Conducted Telephone Number
211 $0'~ 540 ice- C~'/ C-115~ 241- yoo 8
t
Property Owner 1 t Parcel ID # Page Z of 5 J
❑ Boring
Boring # ® Pit Ground surface elev. f f d U ft Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Colo Redox Description Texture Structure Consistence Boundary Roots GPD/fF
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 'Eff#2
I o- "f- ID r3/2- i/ 6t mFr- 5 Ivy -5
2 I y- yo 16 ~L 3 - Sit c 5 _ 8
M-5 YY-N
At IS-, p s Sil d~
GtP/ti~:d
❑ Boring # ❑ Boring
❑ pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/if
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
F-1 Boring # Pit Boring
❑ Ground surface elev. ft Depth to 1'unniting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. `Eff#1 'Eff#2
Effluent #1 = BODS > W:< 220 mg/L and TSS >30 150 mg/L ` Effluent #2 = BODS a 30 mg/L and TSS 30 mg/L
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.
SBM330 (X07/00)
Property Owner ? 1 Parcel ID # Page Z of 3
Boring a # ® Boring
pit p Ground surface elev. 9 • O U ft Depth to limiting factor / in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDNf
in. Munseil QU. SZ. Cont. Color Gr. Sz. Sh. 'EMM 'Efl#2
14 r Z- ;l rn-Pr 5 I,r~ .5
o-~~ I D
cs 8
Z f y-yo 3 Sid 2an~U (Y
4b-lb !d r`f m m I - -7 / Z
F-1 Boring # ❑ Boring
❑ Pit Ground surface elev. ft Depth to limiting factor in. Soil lication Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff#1 'Eff#2
a Bwft # ° Boring
❑ Pit Found surface elev. ft Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDW
in. Munseli Qu. Sz- Cont. Color Gr. Sz. Sh. 'Eff#1 'Effil•2
• Effluent #1 = BOD5 > 30 < 220 mg& and TSS >30:5 150 mg/L ` Effluent #2 = BODS < 30 rng/L and TSS < 30 mg/L
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 608-266-31 S 1 or TTY 608-264-8777.
SBD4330 (R.07100)
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PAGE S OF 3
NAME S ?D y LOT# LEGAL DESCRIPTION <,E- X S F_ 14 ,S It T Z `(.N.R. 1 E(or
SCALE: 1"= %6 Elk w
BM 1 ELEVATION /'~YO• a
BM 1 DESCRIPTION /6p o lo,~k Z "i4t k
BM 2 ELEVATION 9 V,
BM 2 DESCRIPTION 4je S-P c
w~ 9G•
SYSTEM ELEVATION 4-r jG. c)
ALTERNATE ELEVATION fs'
CONTOUR ELEVATION 9y a~T ~OV . o I x
lko,eA /
44
t k
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SIGNATURE \y, DATE O r L