HomeMy WebLinkAbout12-25m m^-L2^S-
<^-C>o2--l4ORIGINAL
Wisconsin Department of Safety & Professional Services
Dh/telon of Industry Ssrvicas
SOIL EVALUATION REPORT
Page.Z_afA
In accordance with SPS 385, Wis, Adm. Code
Attach complete stte plan on paper not less than 81/2x11 inches In size. Nan must indudB.
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.
Plaase print all Information.
Personal Information you prosrtde may be used for secondary purposes (Privacy t-aw, s. 15.04(1){m)).
County ^^u
Parcel I.D.
Ajr 3U. -t^3S>6^l
Rsvls^d^,;•MM z^_^/^-G-
E (or) W
Property Owner
/^•>- S ^^i&^^ 3'^ t£-6T/H.
Property Location
Govt Lot %y<s<c^ T H3 N R^>7
Property Owner's Mailing Address
Wfff- rr-^y^-^ ^
I Site Address or CSM and Lot ft ^3e> r Tft^ I -T« <" /Sst. Zor? <:^-*t
1*< Mff /» ^*'r ^.<'7v ^ /e> '»»<A^ -?<»^/^ -s^/S-ia.
City. State, Zip
<^^/^ Wl -sy^t
Phone Number
( }
D City Damage iS'Town^/^r^u z^, ^
Code derived daslgnflow rate.
Flood Plan elsvation If applicable.Jt.
Q New Constructton use: Bl?BStdentlal/ Numberofbedromns ^
D Public or commercial - Describe:.
Parent material /^fa^&f /Ota7~liJtf A, _. /''f Z 7'^
General comments and recommsndaUons: ^ Tre^^{-f: W/ S^L-P^^ ^.^ ft) c.y^r-e^. ^r'^.. o4 9^r^
Boring #iBortng) Pit Ground surface atav/<"iPT ft.Depth to limiting iadta^ffS in. / elev^^.
Horteon2on
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Depth
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Redox Description
Qu. Az. Cont. Color
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Texture
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Stmcture
Gr. Sz. Sh.
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jgplt Ground surface etev.&L
Conslstence
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ntting factory
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Soil Application Rate
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Dominant Odor
Munsett
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Redox Descriptton
Qu. Az. Cant Color
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CST Name (Pteass Print)^/<S/^^ A^LL^
; Address //jl/)a ^SffwJi&.Sf^ 'sir
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Date EvatuaUon Conducted//^g^2j
Boundary
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Soil Application Rata
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C8T Number
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Telephone Number7^-^Y-//yd
* Effluant #1 = BOD > 30 & 22Q mg/L and T8S > 30 st ISO mffl.• Effluent SZ a BOO. S 30 mgfl. and TSS st 30 mfl/1-SBD.833D (R03/22)
w^ ^so.oo ^lis(2ozs «a\
SR-002J1)
Department of Safety & Professional Services
Industry Services
ORIGINAI.Pam';ii
-of.
SOIL EVALUATION REPORT MAR 1 0 ,025
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
t&
Parcel I.D.
T^. ^!. -tt-38>62r1
Reviewed by Date
Property Owner
t/€^iry s ^l£s^/&^-l-^ 3-/e l.^ ^T /a.
Property Location
Govt. Lot %1/4 S C{> T VJ N R^7
D- 1
E (or) W
Property Owner's Mailing Address
yyj^ r^//^-^ ^j
I Site Address or CSM and Lot #: y</Jz> 5~ Tf«:i I I^ln ^. t-€>ri <^-^
\^,t(^ /n 6^r /.fTs &rf /£> ''^i Jff^. •Zo^.l^-S^/^^2.
City, State, Zip
^^/^ l^Z S~V^ i
Phone Number
( )
D City d Village B. Town^/^"Nearest Road
7/i»<t// X/i^ ^
D New Construction Use: &Residential/ Numberof bedrooms 3
D Public or commercial - Describe:
Parent material /r/a^'&l /OA7~&/-r <^
Code derived designflow rate $/<Z?GPD
Flood Plan elevation if applicable_ft.
General comments and recommendations:^ 7w^< ^/zFZ--^^^ ^,7 ^? ^^^- ^^. c^ ?^ ^
Boring #D Boring12 Pit ft.Depth to limiting factoi^ in./elevi?^.
Horizon
J_
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Depth
In.
0-^
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y<?-^
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Dominant Color
Munsell
7.s-y< -^
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K y-y
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Redox Description
Qu. Az. Cont. Color
C.S.d S-f<. ^
s7or$
Texture
^ ^
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Structure
Gr. Sz. Sh.
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J?^5^K
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Consistence
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Boundary
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£rW
Roots
/c<»(/^
l^f~/a-
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Soil Application Rate
. GPD/Ft2
*Effff1
_!.
-^
.2.
_7_3:
*Ef?2
/.^
/.^
.<^^^
\2 Boring #QBoring
0Pit Ground surface etev.,Depth to limiting factor'^ in. / etev^^ft.
Horizon
J_
-<LT
_^_^
Depth
In.
(?-€»
^-,4
U-3^
n-^o
^-,^8
Dominant Color
Munsell
?/s~ yev^
^/lJ2£
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Redox Description
Qu. Az. Cant. Color
c.3.4 yys. s~^
^f^rf
Texture
/ -f
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y-z:
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Structure
Or. Sz. Sh.
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Consistence
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Boundary
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Roots
/£.0l^t:^
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Soil Application Rate
GPD/Ft2
*Ef?1
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I CST Name (Please Print)
^,'€^a^ ^.^U.^
^ Address ^ 3t>^> ^S^^^a^ ^r
;^<» A l ^ U>1. S-V!i\'
Signature
Date Evaluation Conducted
^-8-^21
CST Number
^^ GiZlC^o^) I
Telephone Number
7^- ^( ~ // ?z?
' Effluent #1 = BOD > 30 6 220 mg/L and TSS > 30 s, 150 mg/L ' Effluent #2 = BOD, £ 30 mg/L and TSS & 30 mg/L
SBD-8330 (R03/22)
Boring#
D Boring
0plt Ground surface e!sv.',Tm.ft.
_^of_i_
Depth to Rmlflng factoryIn. / ele^|-7^t.
Horizon
/
'A-z
-£
Depth
In.
^-(?
T^~
z&^sr
y-T-/<<8
Dominant Color
Munsell
2-rr-e y^_^^_
*. ffy
y/if
Redox Description
Qu. Az. Coftt Color
e.^s-M %
Texture
^?z
u.
5^
C&S
Structure
<3r. Sz. Sh.
^^ <£-^
^^i S~£A-
€3 W_
^~s^-_
ConstetBnce
^/£^€
•Wf ft 'ft.~3~H~
w^.
Boundary
^£^
t5-^/
^•{^
Roots
/^vf
^^:
^f-
Soil AppltedUon Rate
GPD/Ft2
*Ef»1
L-Z.
.^.
. ^
_7Z
•EfffS
^&
,.^3^J"
7^
Boring*a Boringam Ground surface etav..-ft.Depth to limiting factor.JrUelsv...-ft.
Horizon Depth
In.
Dominant Cotor
Munseil
Redox Descriptton
Qu. Az, Cont. Cotor
Texture Structure
i3r.Sz.Sh.
Consistence Boundary Roots
jpilAppttosHonRato
GPD/FP
-EffifM *Efse
Boring^a Boring .
a pit Ground surface etev..Depth to tfmiting factot.Jn./eisv,,
Horizon Depth
In.
Dominant Cotor
Munacll
Rsdox Dascription
Qu* Aac. Oontt Celer
Texture Stmcturs
Gr. Sz. Sh.
Cmsfstence Boundary Roots
Soil Apptteatton Rate
GPOW
•Em_*6ffS_
• Effluent #1 = BOO > SO S 220 mfl/L and TSS > 30 £ 150 mg/L * Effluent #2 = BOD. s 30 mg/L and TSS g 30 mg^L
<^jT^/ S/°~ O{^^e>ffl(
7/.T'-^»-- tl9e>
LV
BAYFIELD COUNTY
CHECKLIST FOR CERTIFIED SOIL TESTS
Submit the Following (Use Permanent Ink); ^p
D Check List :, -. j
a Index Page / Title Sheet (Optional)
D Original Soil Evaluation Report (Submitted in Deed Holders Name - nfit 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)
BTarcel Identification Number (must be 23Jiait Tax ID#) DO NOT USE 12 digit, they are no longer being used
C9^roperty Owner's Information (not prospective buyer's name)
Location (Accurate Legal Description with Sec/Twp/Range)
B^oad Name (where driveway is/will be coming off of)
B^loodplain Elevation, Flow Rate, Comments and Recommendations
B^Complete Soil Boring / Pit Information
B^6ate Soil Evaluation was conducted
'CST Name, Signature, Number, Address and Phone Number
a *Date Stamp*
Plot Plan: (Include the following information drawn to dimension or to scaie)
0'Bench Mark (Description, Elevation and Location)
B^ontour Lines (Example = 98.0'/96.0' ,94.0')
B^roperty Location (Sec/Twp/Range// Accurate Legal Description)
B^Borings (Locations and Elevations)
B^ercent and Direction of Land Slope
EfWell Location (Including Neighboring Wells, if applicable)
£3/focation of Wetland Areas, Floodptain and Navigable Waters
Q^Buildings, Driveways, and Structures (Location and Descriptions)
B^ocation of Property Lines
System Location
'Address Number and Road Name
E'Current Surface Elevation of Wetlands and Navigable Waters
'CST/ Owner and Property Information
Arrow
Fee;
a^Certified Soil Tests - Review & Filing Fee $ 50.00 U/forms/sanltary/checklist/checklistforcsts