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HomeMy WebLinkAbout032-2167-38-000 _ T > J/ I F „{ Wisconsin Departrtl'M of Commerce 04 SOIL EVALUATION REPORT Page / of Division of Safety and Buildings 4 e with Comm 85,Wis. Adm. Code (�� � County Attach complete site pla ,man 8 1/2 x 11 inches in size.Plan must include,but not limited to: { norizontal reference point(BM),direction and Parcel I.D. ^� percent slope,scale or dim, —ins,north arrow,and location and distance to nearest road. 32 Please print all information. ev' wed by Date Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). oZ t Propert Owner Property Location T ovt. Lot 1/4 1/4 S T N R (or Property Owner's Mailing Address Lot# Block# Subd.Name or CSM# Z1302 LQ 8 City State Zip Code Phone Number ❑City ❑Village Town Nearest Road New Construction Use: Residential/Number of bedrooms Code derived design flow rate GPD ❑Replacement ❑ Public or commercial-Describe: Parent material 0"4&6.,/ Flood Plain elevation if applicable ft, General comments and recommendations: ❑ Boring# [] Boring Eg 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/ft2 in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. *Eff#1 *Eff#2 / 6 's s 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/ft2 in. M©unsell Qu.Sz. jCont.Color Gr.Sz./Sh. *Eff#1 *Eff#2 X sb �("Xi S 1 7' 7 s - *Effluent#1 =BOD5>30<220 mg/L and TSS>30<150 mg/L *Effluent#2=BO 5<30 mg/L and TSS<30 mg/L CST Na e leas Pri Signat e CST Number Addre s Date Evaluati Conducted Telephone Number A J ' �_' - _ s SBD-8330(R07/00) Property Owner "? Parcel ID# Page L� of ❑ Boring 1-31 Boring# � 3�i ® Pit Ground surface elev. ft. Depth to limiting facto in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu.Sz. Cont.Color Gr.Sz.S//h. *Eff#1 *Eff#2 K (, s f s r ❑ Boring# ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. S oil 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 F-7T F-1 Boring# ❑El pit 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/ftz in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. *Eff#1 *Eff#2 *Effluent#1 =BOD5>30<220 mg/L and TSS>30<150 mg/L *Effluent#2=BOD5<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. SBD-8330(R.07/00) • �bsaa l�/l s�/C 9� ,�.. ti __ __ _ _ _ __ _ _ _ __ -- __