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Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of -3
Division of Safety and Buildings
in accordance with Comm 85, Wis. Adm. Code County
Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must Cr -6
include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. 11 2 ~m
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. 0 3 13 7" C9~ ~
Re ad Date
Please print -7 - ?j / 3J63
Personal information you provide may be used r secondary purposes (PM *6y Law. 15.04 (1) (m)). r~( /tom
Property Owner roperty Location
T 30 N R aU E (or)
/ M 8 n ovt. Lot ,VU f 1/45W 114 S7
Property Owner's Mailing Adiftess of # Block # Subd. Name or CSM# r
6 726 -54111'ak s,e •c•-s a4r-.
City State Zip Code Phone Number ❑ City ❑ Village Town 'Nearest Road 9Z (6 lLf -S4 Y
3s/G D New Construction Use: Residential / Number of bedrooms 3 - 14 - Code derived design flow rate Sa /6 O GPD
❑ Replacement ❑ Public or commercial - Describe: ~j
Flood Plain elevation if applicable ft.
Parent material I
General comments s~s4-.e yy~ e (-e,tJ . qCp y _ / 7
andrecomm ndation~s~~,,/ ci s Cd~ 0i_r,1Lt/ky,~ IOJW 3 v~z'uiW WA,~'k-
❑ Boring
Boring #
pit Ground surface elev. qj. q0 ft. Depth to limiting factor b in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
6-(b Ib 31 Z Si ( Zr bk r'n r C-5 I v S g
I D 14 5)- e-I Z b ar C-5
ID rsl ,nns nS ran 1 - - 1 2
"dcr'
❑
7 Boring
Depth to limiting factor / in. Soil Application Rate
Boring # Cn. Pit Ground surface elev. 0 ft.
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/112
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
6-i2. 1.(-3)2- r_ 50 zwlabK r C5 (v-~
2 12.--45 cI 2 rr,~lr C-
3 LIS - 7 ~ d Srr~F
Effluent #1 = BODs > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BODs < 30 mg/L and TSS < 30 mg/L
CST Name (Please Print) 1 Signature CST Number
~wmgKer Z-6-5 309
Date Evaluation Conducted Telephone Number
Address
Zl\3 c6pT~' ~ Sbc-,r-,e~~- ~l~.S 1 5`{tSLs_ ~ _715 ) 2_4 7_4_/ co
~
16 r
Property Owner _QJ5 f t aqG f6Yy}e g `
Parcel ID Page 2- of
F3] Boring # ❑ Boring f c[
~ Pit Ground surface.elev. q / ZU ft, , Depth to limiting factor r In.
Horizon Soil Application Ra
Depth Dominant Color Redox Descriptbn Texture Structure Consistence Bounds
In. Munsell Uu. Sz. Con: Color rY Roots GPD/f*
Gr. Sz. Sh.
3/ 'Effg1 Effg2
/0 '
•2 S°.. b ~r ~5 I ~
`f Io [ 'I C-1 2mS
F-1 Boring # ❑ Boring
❑ pit Ground surface elev. ft. Depth to limiting factor In.
moil Appliption Rai
Depth . Dominant Color Redox Description.... Texture Structure Consistence Boundary Roots GPD/fl'
Horizon In. Munsell Qu. Sz. Cont. Color Gr. Sz Sh.
'Effgi 'Effg2
EEE
❑ Boring # ❑ Boring
❑ Ground surface elev. Pit ft. Depth to limiting factor In.
Soil Application Raft
Horizon ri pt h Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ht
. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh.
'Effg1 'Effg2
' Effluent #1 = BODs > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOOS < 30 mg/l, and TSS < 30 mg/l.
The Depart ment 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 1-1-Y 608-264-8777.
SM3330 (R.07M)
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NAME Oc(rrt" LQT# LEGAL DESCRIPTION tiW Y4 W19
r
SCALE: I"= elBM I ELEVATION 1,90,
BM I DESCRIPTION~afT l , a c- Age
BM 2 ELEVATION y9v
BM 2 DESCRIPTION f c e
SYSTEM ELEVATION c/Co • S~
SYSTEM TYPE 0o n u c +-o -
CONTOUR ELEVATION oo vd
Q,Z
~aD
SIGNATURE DATE
I-1,°v