HomeMy WebLinkAbout026-939-20-5511-CST-2021-198 �;;,��.��;; ' f � d�� Q�'�CA^Cr�'� � � D�4��P������� P e � of
_ Wsconsin Department o Sa ety&Professional Services `����n � ag � n
• � : Division of industry Services S
' _�_ ." SOIL EVALUATION REPORT _ �'
In accordance with SPS 385,Wis.Adm. Code County �
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Attach complete site pian on paper not less than 8 1/2 x 11 inches in size.Plan must include, �A'W e 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. -9 — "SO$ f
Please print all information. Reviewe y� D te / _�
Personal information you provide may be used for secondary purposes(Privacy Law,s.'15.04(1)(m)). I � �aY �3 �
Property Owner Property Location � �
k. � L� Govt. Lot $ %, '/. S � T 39 N R � E(or) W
Property Owner's Mailing Ad ress Site Address or CSM and Lot#:
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City, State,Zip Phone Number ❑ City ❑Village �Town Nearest Road
ava e MN SS3'7 ( ) 14. Sc..n� l.alce Rd
�NewConstruction Use:� Residential/Numberofbedrooms .3 Code derived designflowrate yS� GPD
❑ Replacement ❑Public or commercial—Describe: Fiood Plan elevation if applicable ft.
Parent material �S,�k�,✓a.g 1�
General comments and recommendations:
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❑ Boring# ❑Boring
y �Pit Ground surface elev.9D•S�Dft. Depth to limiting factor>7 3 in.�elev.S`I•y,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
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❑ �Boring
Boring# �p�t Ground surface elev. ft. Depth to limiting factor in./elev. ft.
Soii Application Rate
Horizon Depth Dominant Color Redox Description Teuture Structure Consistence Boundary Roots GPD/Ft2
In. Munsell Qu.Az.Cont.Color Gr.Sz.Sh. •Eff#� `Eff#2
CST Name(Please Print) Signature , CST Number
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Address Date valuation Conducted Telephone Number
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'Effluent#1 =BOD>30<_220 mg/L and TSS>30 5150 mg/L `Effluent#2=BOD,5 30 mg/L and TSS<_30 mg/L SBD-8330(R03/22)
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