HomeMy WebLinkAbout032-2167-45-000 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of ,S
Division of Safety and Buildings
in accordance with Comm 85,Wis. Adm. Code
County C
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. Q 3�.� ��tp?� ��• d
Please print all information. Rev wed by Date
Personal information you provide may be used for saconctBpCpur�oses(Privacy Law,s.15.04(1)(m)). �zf
Property Owner tiw Pro erty Location
Go t.Lot 1/4 ., 1/4 S T N R E(or�l
Property Owner's Mailing Address Lo. # Blocly# Subd.Name r M#
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City St te Zip Code Phon6_Nd Tibor City ❑Village IR Town Nearest Road
New Construction Use_k Residential/Number of bedrooms Code derived design flow rate GPD
❑Replacement ❑/ Public or commercial-Describe:
Parent material Flood Plain elevation if applicable ft.
General comments
and recommendations:
F/_1 Boring#
E] Boring
Jtj Pit Ground surface elev. 7 �ft. Depth to limiting factor 33G 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
-G
c 7
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l
E] Boring
Boring# ��77II
1LJ 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
-7
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Eff1pent#1 =BOD5>30<220 mg/L and TSS>30<150 mg/L Effluent#2=BODS<30 mg/L and TSS<30 mg/L
CST Nam ase i ' tSig nature /��Y/, CST Number
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Address Date Evaluation Conducted Telephone Number
SBD-8330(R07/00)
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Property OwnerQ Parcel ID# Page + _ -of 3
Boring# ❑ Boring
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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 I *Eff#2
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j $ t
I
F-1 Boring# ❑ Boring
r and surface elev. ft. Depth to limiting factor in.
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❑ Pit ME 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
i
❑ 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
*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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