HomeMy WebLinkAbout002-940-26-5304-CST-2021-173 ���Ki:��i� .
(='� �,, Wisconsin Department of Safety 8�Professional Services Page ( of � n
� \'. Division of IndustryServices
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, �J\ P�� SOIL EVALUATION REPORT —1
\"`-�` �"' In accordance with SPS 385,Wis.Adm. Code County
�"��,�:�!-\` � 12.)
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 percent slope, Parcel I.D. �
scale or dimensions,north arrow,and location and distance to nearest road. _ 9 _ �.I" --
Please print all information. Review by Date '�
Personal information you provide may be used for secondary purposes(Privacy Law,s. 15.04(1)(m)). (�l/ � (� .,t�.
Property Owner Property Location �
�1 ; LLC Govt. Lot 3 '/, '/< S � T y� N R 09 E(or) W
Property Owner's Mailing Address Site Address or CSM and Lot#:
'�1�'7 N '� Av Lo� 1 C s h 3'7 . J �I 5
City, State,Zip Phone Number ❑ City ❑ Village �Town Nearest Road
� W= ( ) c1 C � lt
�NewConstruction Use:�Residential/Numberofbedrooms�_ Codederiveddesignflowrate 00 GPD
❑ Replacement ❑ Public or commercial—Describe: Flood Plan elevation if applicable N t A ft.
Parent material C�1o.c;o.� ��k,..,as1�
General comments and recommendations: __ _ �1r"1 Q�h���''
1
u Boring# ❑Boring �
�7 �Pit Ground surface elev.��V��. Depth to limiting factor !00 in./elev.�./7 ft.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/Ft2
In. Munsell Qu.Az.Cont.Color Gr.Sz.Sh. *Eff#1 *Eff#2
1 0-(. `t 3/ � � 0:7 I.b
J G-i YR yly — fo � �r o.7 �.
3 �7-30 �.SYR `�I -- 5 � 1 0.� i.
30- 10(� 7.5"'f R s/w `� S ,.� � o.� 1. (,
�,Ze•n .1- r r t S�
❑ �Boring
Boring# �Pit Ground surface elev. ft. Depth to limiting factor in./elev. ft
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/f=t2
In. Munsell Qu.Az.Cont.Color Gr.Sz.Sh. •Eff#1 *Eff#2
N
N Y
SA M1N�S�R
CST Name(Please Print) Signature CST Number
, ���.r s- �/� a�c�88
Address Date valuation Conduc d Telephone Number
o nl �c ��-'7 l�a wPrd wI s'� y3 ► i /a i � �'3 - s58-Gy'7>
*Effluent#1 =BOD>30<_220 mg/L and TSS>30<_150 mglL `Effluent#2=BOD,<_30 mg/L and TSS<_30 mg/L
SBD-8330(R03/22)
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