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RECEIVED 5: i - Eve ooq
Wis. Dept of Safety and Professigr},*lSeivices SOIL EVALUATION 'age / of
Division of Safety and Buildings
in accordance with SPS 385, Wis. Adm. Code
County J C lv
Attach complete site plan on paper not less than 8 1/2 XI 1 inches in size. Plan must
include, but not limited to: vertical and horizontal reference point (BM), direction and
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. J 7~ _ //I "
L
Please print all information. Review by J Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). 3 '~7
Property, Owner /-/0, ~ Property Location ~
/ Govt Lot N~ 1145 _ 114 TN R $ (orC
Property Owner's Mailing Address Lot # ?i;-cic-# Subd. Name Sr CSM#
l/Z ,.2Cf s" l
Ci State Zip Code Phone Number
YUBZ [I City ❑ Viilage ®Town Nearest Road
❑ New Construction Use: ❑ Residential / Number of bedrooms 3 Code derived design flow rate GPD
® Replacement ❑ Public or commercial - Describe:
Parent material
/ Flood Plain elevation if applicable
General comments S yS~G~h` 9'~
and recommendations:
Boring # E] Boring
1
E] pit Ground surface elev. ft. Depth to limiting factor ~Z Y in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft 2
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. ff#1 ff#2
Y-r 7. 6, 6
16 0, -7
yi~y ~e 7s ~s p) L - - 7
Boring # Boring
® Pit Ground surface elev. ft. Depth to limiting factory
in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft z
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ff#1 ` ff#2
-~Iz S'L P? c t- l m , y C), 7
y IX 7C) /o f 6~ r-r C- u- O , -7
Effluent #1 = SOD > 30:< 220 mg/L and TSS >30 < 150 mg/L ` Effluent #2 = BOD t < 30 mg/L and TSS < 30 mg/L
CST Name (Please Print) Si tune CST Num r
131_1, ~,l e me/l l 2113 M
Address Date Evaluation Conducted Telephone Number
76 Z Y ~z(
- - -
SBD-9310(RI3/11)
Property Owner Ire` Parcel ID# y✓ ~~~57 [ ~~//G Page Z of
❑ Boring V
FTI Boring #
E3 pit Ground surface elev. ft. Depth to limiting factor7Ly-/in• Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture structure onsistence Boundary Roots GPD/ft z
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ff#1 ff#2
Z 12-23 Ts 79 / I~IA cry
%Di Ai ~76--- L s OJ j, 7
❑ Boring # ❑ Boring
❑ Pit Ground surface elev. ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft z
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ff#1 ff#2
❑ Boring
❑ Boring # Ground surface elev. ft. Depth to limiting factor in.
❑ Pit Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft 2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ff#1 ' ff#2
I
' Effluent #1 = BOD 5 > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L
The Dept. of Safety and Professional Services is an equal opportunity service provider and employer. If you need assistance to
access services or need material in an alternate format, contact the department at 608-266-3151 or TTY through Relay.
SBD-5330 (RI 1/11)
i
OWNE Page 3 of 3
Name e pot Brian Parnell
Address 6- Zo ~ti rr; CST 231314
m -e- 1 SY68.2 Date j 2- 2- 4
A Benchmark 1 Wa /*6 U
♦ Benchmark 2 Tod I'Yt a 4 ffo% c o v ei
Soil Boring
i_ Suitable Area
1 " = 40' Scale
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