HomeMy WebLinkAbout48-24 McCarverORIGINALWisconsin Department of Safety & Professional Services
Division of Industry Services
SOIL EVALUATION REPORTS -•
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In accordance with SPS 385, Wis. Adm. Code
Attach complete site plan on paper not less than 81/2x11 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.
Please print all information.
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04(1 )(m)).
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Property Owner
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Property Location
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D New Construction Use: B" Residential / Number of bedrooms Y
0 Replacement D Public or commercial - Describe:
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Date Evaluation Conducted7//^/^i,Telephone Number?^-^f- //?^
• Effluent #1 = BOD > 30 £ 220 mg/L and TSS > 30 & 150 mg/L * Effluent #2 = BOD, & 30 mg/L and TSS s 30 mg/L ;
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Effluent #1 = BOD > 30 < 220 mg/L and TSS > 30 <. 150 mg/L * Effluent #2 = BOD, < 30 mg/L and TSS & 30 mg/L
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H/7ti^ BAYFIELD COUNTY
CHECKLIST FOR CERTIFIED SOIL TESTS I ill!
;i!! APR fC'^W WSubmit the Following (Use Permanent Ink):
D Check List
D Index Page / Title Sheet (Optional)
D Original Soil Evaluation Report (Submitted in Deed Holders Name - not prospective buyers)
d Original Plot Plan
D Cross Section Soil Profile Sheet (optional)
D Additional Information (Warranty/Quit Claim Deed) (Optional)
Soil Evaluation Report: (Include the following Information)
B'Parcet Identification Number (must be 23_djflit Tax ID#) DO NOT USE 12 digit, they are no longer being used
[yT'roperty Owner's Information (not prospective buyer's name)
B^roperty Location (Accurate Legal Description with Sec/Twp/Range)
B^Road Name (where driveway is/will be coming off of)
D Floodplain Elevation, Flow Rate, Comments and Recommendations
S^omplete Soil Boring / Pit Information
B^ate Soil Evaluation was conducted
B'tfST Name, Signature, Number, Address and Phone Number
D *Date Stamp*
Plot Plan: (Include the following information drawn to dimension or to scale)
B^ench Mark (Description, Elevation and Location)
B'Contour Lines (Example = 98.0'/96.0794.0')
B^Property Location (Sec/Twp/Range/, Accurate Legal Description)
and Elevations)
lypercent and Direction of Land Slope
B^/Vell Location (Including Neighboring Wells, if applicable)
[yCocation of Wetland Areas, Floodplain and Navigable Waters
B^uildings, Driveways, and Structures (Location and Descriptions)
0/Location of Property Lines
System Location
EfAddress Number and Road Name
EfCurrent Surface Elevation of Wetlands and Navigable Waters
lE^CST, Owner and Property Information
Ef North Arrow
Fee:
D Certified Soil Tests - Review & Filing Fee $ 50.00 U/forms/sanitary/checklist/checklistforcsts