HomeMy WebLinkAbout032-2167-41-000 (2) RECEIVED
Wisconsin Department i fCommerce SOIL EVALUATION REPORT Page-,/ Of
Division of Safety and B ildings
FEB 1 7 jiWiglance m 1th Comm 85,Ws. Adm. Code
County
Attach complete site an on paper not less than 81/2 x 1 inches in size.Plan must
include,but not limite to:vdttiTaVaWWbWhMTR(feren point(BM),direction and Parcel I.D.
percent slope,scale dimensions,north arrow,and 14—on and distance to nearest road. 301 — ). -7-411-czb
Please print all information. Re 'ewed by Date
Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). EKE, ZZ 260
Property er Property Location
Govt.Lot, 1/4 1/4 T� N R Z2 (or
roperty Owner's Majiiiig Address Lot# Block# Subd.Name or C
City S e Zip Code Phone Number n City ❑Village gTown Nearest Road
New Construction Use:f Z Residential!Number of bedrooms Code derived design flow rate e� GPD
❑Replacement ❑ Public or commercial-Describe:
Parent material_�, Flood Plain elevation if applicable ft.
General comments
and recommendations: ��5��c,,, f� 9� C
F 71 Boring# Fip1I Boring
1� Pit Ground surface elev., � , ft. Depth to limiting factor /•Sin in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/W
in. Munsell Qu.Sz. C nt.Color Gr.Sz.Sh. *Eff#1 *Eff#2
1
4 9
I
aBoring# E] 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/fF
in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. *Eff#1 I *Eff#2
7
� 4
t✓ tL
Q q
*Puent#1=BOD >30<220 mg1L and TSS>30:5 150 mg/L - vent#2=BOD <30 mg/L and TSS<30 mg/L
CST (PI Print - ' Signature CST Number
Address Date Evaluation Conducted Telephone Number
J
Property Owner Parcel ID# Page of
9 ba 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/fF
in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. *Eff#1 I `Eff#2
-3 s�
R R
F 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/fF
in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. *Efr#1 *Efr#2
❑ Boris Boring
# ❑
E] 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/fF
in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. *Eff#1 *Eff#2
*Effluent#1=BODS>30<220 mg/L and TSS>30:5 150 mg/L *Effluent#2=BOD$<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.
813o-e330 tx.07i00>
v _
LI Jk.. lb, z '
t
y
r
n h Q
V t
W
1�
N _ Rob
moz
too- 2Z
i ,
ca
r �
0
31't / -
y c-P4 -
- o
_ _ s
ti0S
OD
/ n ,-�i
O
OD
-..
N O � 406 C -_
Z 4 y M` _
_ 37't
r
254.16
°® m
yy
+-- .,..,
VVisconsin Department of Commerce SOIL EVALUATION REPORT i Page of
Div4sion 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.
Please print all information. Reviewed by Date
Personal information you provide may be used fQc s(Privacy Law,s.15.04(1)(m)).
Propert Owner „ , w ye _ �I roperty Location
ovt.Lot 1/4 1/4 T N R G E(o
Property Owner's Mailin Address �" n7 of# Block# Subd.Name or CSM#
ity State Zip Code Ph rie t�ttfrlber ;, ! ❑City E]Village f�Town Nearest Road
New Construction Use:: Residential/Number of bedrooms Code derived design flow rate /(y GPD
❑Replacement ❑ Public or commercial-Describe:
Parent material a ZA4&- 3 Flood Plain elevation if applicable ft.
General comments / c
and recommendations: �!"Iw i;�,� . � 9G•O � _ /� � (� ��n d p (y,,,Q�
M Boring# ❑ Boring
Pit Ground surface elev. 9G'd� _ft. Depth to limiting factor i .
Soil Applica lon
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
G L
Ln 0
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. Munsell Qu.Sz. Pont.Color Gr.Sz.Sh. *Eff#1 *Eff#2
s-ys/ _
*Effluent#1 =BOD5>30<220 mg/L and TSS>30<150 mg/L *E Went#2=BODS<30 mg/L and TSS<30 mg/L
CST Name Pleas Pr Signatur CST Number
Z�
Ad r ss ate Evaluation Conducted Telephone Number
SBD-8330(R07/00)
�S
�Y.
Property Owner Parcel ID# Page of
E Boring#
l 1A❑ 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. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. *Eff#1 *Eff#2
el
cJ �F lP
❑ 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. 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.
El pit
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
*Effluent#1 =BODS>30<220 mg/L and TSS>30<150 mg/L *Effluent#2=BODS<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)
k.0
we
A i
i
i
l