HomeMy WebLinkAbout026-939-20-5512-CST-2021-197 � $N ��
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Wisconsin Department of Safety&Professional Servic�~�., '-, 3 Page � of �- �
Division of Industry Services �`3 ��` ������ � (n
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� ' ._�_ ." SOIL EVALUATION REPORT �
,;�,;, ����\`\ In accordance with SPS 385,Wis.Adm. Code County .•
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size.Plan must include, ��w� �'r
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_ aa.(o-� S- a0 O
Please print all information. Reviewed by D te `�
Personal information you provide may be used for secondary purposes(Privacy Law,s. 15.04(1)(m)). � �t/ I � �Yl�
Property Owner Property Location � �
a 1� a �o L(r G Govt.Lot � '/. '/. S �O T 39 N R � E(or) W
Property Owner's Mailing A dress Site Address or CSM and Lot#:
�o y 3 L,� a G.sn�i 8s�9 v.37 .�y o w
City,State,Zip Phone Number ❑ City ❑Village �Town Nearest Road
M N S 37 c > C, Sa�c' Ga1te Rd
[�NewConstruction Use:�Residential/Numberofbedrooms 3 _ Code derived designflowrate 45�GPD
❑ ReplBcement ❑Public or commercial-Describe: Flood Plan elevation if applicable — ft.
Parent material CSv�r wasL.
General comments and recommendations:
Ac�e ,,,K+ +o G T a�- 9�_
� �Boring
Boring# 93,�7
�Pit Ground surface elev. ft. Depth to limiting factor l7 0� in./elev. 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
( o- I 0 YR� — ) g' rn-+��` 9 ol�rJ� 0•7 1.C
- 19 Y yJY � �5 ?! rnvl�� S )� O."� 1 .L
14- 7,SM1Zy1 —' S � MI S I� U, I .`
L -i �I 7.5YR�Y — S 6 r�l " 1� v. 7 ►.
�Boring
Boring# �p�t Ground surface elev. ft. Depth to limiting factor in./elev. ft.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Strudure Consistence Boundary Roots GPD/FtZ
In. Munsell Qu.Az.Cont.Color Gr.Sz.Sh. *Eff#1 'Eff#2
CST Name(Please Print) Signature �� CST Number
�aro��d A re,c 1 S�
Address Date Ev uation Conduct d Telephone Number
� � w.ra w?sys� s i a�i a a , - s - ti�
'Effluent#1 =BOD>30<_220 m�/L and TSS>30 s 150 mg/L 'Effluent#2=BOD,<_30 mg/L and TSS_<30 mglL
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