HomeMy WebLinkAbout56-24 Hovdeck-0%^
Wisconsin Department of Safety & Professional Services
Division of Industry Services
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SOIL EVALUATION REPORT
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)).
County
Parcel ^^^l"7^< f^ ^^U \
Reviewed by
Al.
Date
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Property Owner
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Property Location
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Property Owner's Mailing Address
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Site Address or CSM and Lot #:^27'^'-s~ 5 T^^c^r ^^ ^. ^7- 5<^'"*%?_Y'i^S7'JJr"<' ^^e-^ "^ '5«:1:^ ^>:rV '^ l-/y>."^-¥^^~ ^_—' -y ^, ^ C<,r\^3,^-b 4eCity, State, Zip
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Replacement D Public or commercial - Describe:
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General comments and recommendations:
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CST Name (Please Print)
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Signature'y^/ '2^^'CST Number
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Address /f?t)e> /3csh.de. <ja.y,Ji 0^7
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Date Evaluation Conducted/7^/^3 Telephone Number
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* Effluent #1 = BOD > 30 £ 220 mg/L and TSS > 30 <; 150 mg/L Effluent #2 = BOD, s 30 mg/L and TSS S 30 mg/L SBD-8330.(R03/22)^SQ ^-y'FM
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4-9
BAYFIELD COUNTYCHECKLIST FOR CERTIFIED SOIL TESTS
MA'?
Submit the Following (Use Permanent Ink):
n 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"Parcel Identification Number (must be 23 digit Tax ID#) DO NOT USE 12 digit, they are no longer being used
ETProperty Owner's Information (not prospective buyer's name)
BTroperty Location (Accurate Legal Description with Sec/Twp/Range)
ETRoad Name (where driveway is/will be coming off of)
a"Floodplain Elevation, Flow Rate, Comments and Recommendations
ETCompIete Soil Boring / Pit Information
CTDate Soil Evaluation was conducted
[UK§T Name, Signature, Number, Address and Phone Number
D *Date Stamp*
Plot Plan: (Include the following information drawn to dimension or to scale)
Q'Bench Mark (Description, Elevation and Location)
CTContour Lines (Example = 98.0',96.0',94.0')
-O^roperty Location (Sec/Twp/Range/, Accurate Legal Description)
'CTBorings (Locations and Elevations)
S15ercent and Direction of Land Slope
B-Well Location (Including Neighboring Wells, if applicable)
Q-Cbcation of Wetland Areas, Floodplain and Navigable Waters
BtSuildings, Driveways, and Structures (Location and Descriptions)
B-tocation of Property Lines
Q-Existing System Location
B-Address Number and Road Name
G-Current Surface Elevation of Wetlands and Navigable Waters
STCST, Owner and Property Information
B^Torth Arrow
Fee:
E^ertified Soil Tests - Review & Filing Fee $ 50.00 U/forms/sanitary/checklist/checklistforcsts