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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 County
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 location and distance to nearest road. 2 ~~SS '01 S ' 7
R Date
Please print p~/~~~,(~ -
Personal information you provide may be used f seconPaS"4 V -Daw, s. .04 (1) (m)). 6 3
Property Owner Pr pertyLocatlon
Loren FE 3 2pnj G Lot E rSubbdd. 1/4 S ZZ T N R E(or)e
Property Owner's Mail!n Address L # Block # Name CSM# ST. CROIX COUNTY 5 Pon p~VY'eA')
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City Stat Zip Code Pho EFICE City C1 Village [Town Nearest Road
c..j wI ry&Y-7 ( 71s) tyQo -sNZ n
`l" New Construction Use: Residential / Number of bedrooms Code derived design flow rate Q GPD
❑ Replacement ' ❑ Public or commercial - Describe:
Parent material I Fbo Plain elevation if p 1lcaabl~e,1-)
General comments LZ6 tat)
and recommendations: S/Tim 1>~
SusPEGT Sy
~/'6.7~' / .B/rl ~ {1' 3~ 2 c~.s~~ ~e v- y r 2 ow
er~f ~ -t4~ i~/alcA°r~S 6M s a,:t" Z40' ~roY►, C rAP_r a.
~/r;3 E A-~ S.r.~ ~ l3e~c~-rrrayeK.s ,>ro ~2- .~o~ [~~3 . .SLaPE >s ~no,2~ sN/ d ~ ~ b-'•
F I ❑ Boring Q
Boring # ft. Depth to limiting factor -LD in.
® ph Ground surface elev. _ Sod Applicationn 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
ca-lo r l 2 r c~ I'T 5
Vr :2,j"3
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Clso (-,n
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❑ Boring
F2_1 Boring # t-a Pit Ground surface elev. ft. Depth to limiting factor _ 7 - in.
I Sol Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fiz
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
c I 5
p ,z s~ l 2 wcb~
z 12, ?_0 LlA/ 2 C -
zo w l& rns
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' Effluent #1 = BOD > 30:5 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L
CST Name (Please Print) nature/ CST Number
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6da W\ Zs
Address Date Evaluation Conducted Telephone Number
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Property Owner -s1 l~ Parcel ID # Page
Boring # ❑ Boring
❑ ® Pit Ground surface elev. q$ 90 ft. Depth to limiting factor 70-in.
Sol Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDlfF
in. Munseli Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 `Eft#2
d-( 1 ,4n - _3 - 5 - 2r>-) jP c s vC 5 ~
Z i2- 1 r - Sr"c I r C.
4 t46-76 (0 r, / - 5~ mSbk m r
❑ Boring # ❑ Boring
❑ Pit rGround.surface elev. ft. Depth to limiting factor in. Sol Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD1fP
in. Munseil Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
Boring
F-1 Boring # Ground surface elev. ft. Depth to limiting factor in.
❑ Pit Sod lcatlon Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDff 2
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff#1 `Eff#2
Effluent #1 = BOOS > 30:S 220 mglL and TSS >30 < 150 mglL * Effluent #2 = BOD5 < 30 mg1L and TSS < 30 mglL
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.
SBD-8330 (R.OVOO)
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PAGE_ !;~_OF3
NAME e r Gl LOT# Z 5 LEGAL DESCRIPTIONuF X tiEl4 ,S ZZ T 34 N R ! E(or
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BM I ELEVATION l(o. 4
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BM 2 ELEVATION 70
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