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Wisconsin Department of Co
SOIL EVALUATION REPORT Y . `g
Division of Safety and Buildings i~a~b~ kk ~ Page ~ of
d}}ante with Comm 85, Wis. Adm. Code
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Attach complete site plan on County
include, but not limited to: v ~ ~ inches size. Plan must
percent slope, scale or `t5,~,,.,~~^ point (BM), direction and Parcel LD. 0
ort arrow, and location and distance to nearest road. -t!', `
Please print all information. Re wed by Date
Personal Information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). C ! /
Property Owner Property Location J c7
j ~3; u r- , l on
L vz Ni S -PE'r-SC7ttIyV v "C Govt. Lot ,~EJ
Property0wner'sMailingAddress 1/4 .~il-(,!1/4 C/ T N R E (o Q
C /W Lot # Block # Subd. Name
city State Zip Code Phone Number ❑ City ❑ Village own Nearest Road
Lea c
2-'New
Construction Use: 91~esidential / Number of bedrooms
Code derived design flow rate ~ C) C.~ Gpp
❑ Replacement ❑ Public or commercial - Describe:
Parent material L 01c--S C ( )01-- 'Y-11 Flood Plain elevation if applicable /j.4
General comments ft•
Handrecommendations: Celt Cor < r-J V
_5 y,5'~-cwt L- ~~v / CC?: S 3
-Z6 Ad-
LZ Boring # ~~/Bfing
L~ 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/ffr
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 "Eff#2
/ G ' Y
77
n 7• K V-K4
E,;E Boring # ~ Big
Plt Ground surface elev. 7 ft. Depth to 1'..-titir,g factor 2 in.
Soil Application ate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fP
in.Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 "Eff#2
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~ Y f x D '7 s ~k
s
' Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 myL _
Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L
bA T Name (Please Print Signature CST Number
dres s Date Evalua 'Conducted Telephone Number
17~
71
ri
VA V\ rsc k" Parcel ID # t t C j Page ID of
Property Owner
Boring # Boring
t Ground surface elev. l ft. Depth to limiting factor r In Soil A lication Rate
3
- GPD/ff
Horizon Depth Dominant Color Redox Description Texture Structure Consistence nBoundary Roots •Eff#1 `Eff#2
in. Munystell Qu. Sz. Cont. Color Gr. Sz. Sh. [
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7. S-~ ill
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Boring # Boring ft, Depth to limiting factor in.
pit Ground surface elev. [-toil Application Rate
GPD/fg
Horizon Depth Dominant Color Redox Description Texture Str ucture Consistence Boundary Roots «Eff#1 «Eff#2
I in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh.
F
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I
Boring -
El Boring # Ground surface elev. ft. Depth to limiting factor in.
❑ Pit Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Cgnsistence Boundary Roots *
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh.
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Effluent #1 = GODS > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BODE < 30 mg/L and TSS < 30 mg/L
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