HomeMy WebLinkAbout032-2167-44-000 ;onsin Department of Commerce SOIL EVALUATION REPORT Page of
Div,,ion 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. Re ewed by Date
Personal information you provide may be used for ondar�qurp8e�(Priaaey Lawt. _15.04(1)(m)). (( 62
Property Owner
Pro erty Location cw�
Golt.Lot SG✓ 1/4 1/4 S T N R E(or&
Property Owner's Mailing Address ° ' p UI;iV Lo j# I Bloc # Subd.N me or CSM#
City State Zip Code jPhone♦ umber City n Village Town Nearest Road
New Construction Use;Er Residential/Number of bedrooms Code derived design flow rate 1-111&7 GPD
❑Replacement ❑ Public or commercial-Describe:
Parent material ,�s,< Flood Plain elevation if applicable ft.
General comments
and recommendations:
� I Boring# 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/ft2
in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. *Eff#1 *Eff#2
'S' 7 X,
Boring# I❑ Boring
I 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
�. s�
S S'
444-3
,
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C �
S
*Effluent#1 =BOD5>30<220 mg/L and TSS>30<150 mg/L *Effluent#2=BODS<30 mg/L and TSS<30 mg/L
CST Name(P a Pn ) Signat e CST Number
Address ate Evaluation Conducted Telephone Number
C S ,
SBD-8330(R07/00)
Property Owner, i;1 iu?lAt9C1./y�sH�ro Parcel ID# Page of
F] ❑
Boring# Boring
�RPit Ground surface elev. ft. Depth to limiting factor in.
jo � 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
/
's
F-1 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/ftz
in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. *Eff#1 *Eff#2
F] El❑ Boring
Boring# Ground surface elev. ft. Depth to limiting factor in.
pit
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)
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