HomeMy WebLinkAbout032-2045-30-300 (4) h(;E1VED
Ws onsin Department of Safety and Professional Services S~ ' ZO t~ ^ O g
Divi ion of Industry Services DEC 3 ~ '46;1.)
SOIL E K*ORT Page-of
in accordance with Co mPMWNV D ENT fZ2 -Z.O~~ - C~ -30 0
County ~ J n
%Jach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must
m lude, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. irk' of
rcent slope, scale or dimensions
Please , print north arrow, and location and distance to nearest road. b 3 _ 404:6 G
all information. Re ed by Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). L
Property Owner Property Location
Govt. Lot 1/ 1/4 T N R E (or) W
Property Owner's Mailing Address / Lot # Bloc # Subd. Name r CSM#
City State Zip Code Phone Number City r]Village Town Nearest Road
New Construction Use0 Residential / Number of bedrooms Code derived design flow rate ) 2 - ZLC GPD
n Replacement rl Public or commercial - Describe:
Parent material, Flood Plain elevation if applicable ft.
General comments ~or x
and recommendations:
M/ Boring # 11 Boring
El Pit Ground surface elev. ft. Depth to limiting factor > --,)L in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fg
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
- -
-
C;r IL
Boring # n 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/fig
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
7
'IV
- - y 4
1
IV I
' Effl nt #1 = BODS > 30 < 220 mg/L and TS 30 < 11, mg/l-` Effluent #2 = BOD, < 30 mg/L and TSS < 30 mg/L
CST Nam lease r / Sign r¢ CST Number
Address Date Evaluation Conducted Telephone Number
SBD-8330 (R07/13)
Property Owner Parcel ID # Page 12- of
Boring # Boring
Pit Ground surface elev. Y / ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fig
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 -Eff#2
L °t
,J
`J. j G
v Y,
I
Boring
El Boring # 4b- 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/ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 *Eff#2
Boring
F-1 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
I
Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD5 < 30 mg/L and TSS < 30 mg/L
SBD-8330 (R07/13)
Property Owner ~ L-n - G Parcel ID # Page_ of
a Boring # on Boring
Pit Ground surface elev. / ft. Depth to limiting factor >4Z--) 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
F s 2 ~s
4L 17
j
El Boring # F]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 'Eff#2
I
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/fF
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 = BOD; < 30 mg/L and TSS < 30 mg/L
SBD-8330 (807/13)
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