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Home My WebLink About29-25S^-00^3>G ^(^^[%y ^^j—a£^^ Wisconsin Departmentof Safety and Professional ServitJ^ Division of Industry Services Q IE18II^ NAY 1 3 20Z5 _of_ SOIL EVALUATION REPORT. .-_i- ,.cod?^®rtm?^eTr Page. SG" TEST .- .39-3.51 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)). <] Property Owner ^ i m $/^-/-T^ -y- Parcel I.D.r^i i>^ j?-///<p Date,//^/3 I ^^ Property Location Govt. Lot %-/<S 1^ T^/7 NR f 7 « Site Address or.CSM and Lot ft ^f- 'ff /^/1r M^ "^~ci'l~-f~^'\~^~^"L-c, ^ iE's-^T-eS L^i~ ^Property Owner's Mailing Address-7 s 03 ^+ ^'iK'r^ City ^Je r'Fh C?,^7/1<_t. StateA/^Zip Code <;5^S^Phone Number (^/2-)^to9 D City D Vjltage, B Town ^-i r-^ i- i^ Nearest Road J /-/fl/^'/no^'.l Ui Public or commercial - Describe: I New Construction Use: 03 Residential/Numberofbedrooms 2-_ I Replacement Parent material 6- ICL&. s ei. i General comments and recommendations: Code derived designflow rate -3DOGPD Flood Plan elevation if applicable_ft. Boring #Q Boring Ipit Ground surface elev. ^V- ^ ft.Depth to limiting factor ~r^^m. I elev._ft. Horizon J_^ ^ Depth In. ^s-Y -zo ^-ji^ Dominant Color Munsell L°Uzzll^47^^ ^Y^-i Redox Description Qu. Az. Cont. Color jU<5^<2 ^J orJf yj ^'^^ Texture ~ST^^ Structure Or. Sz. Sh. ^^k 0 0 Consistence /^ \/4 ^ m ^/' ^L Boundary ~^5~ ^s Roots 5 ^ 3 ^T^Y Soil Application Rate GPD/Ft2 *Eff#1,7T .T ."7 *Eff»2-6~ L-2^ t.'i^ Boring #QBoring ilPit Ground surface elev. / /•'-' ft.Depth to limiting factor ^rin. / elev. Horizon T 2- _s- Depth In. D -5 $~-^ TA-\\^ Dominant Color Munsell lO^^/j. S'^R ^ ^n^ ^ Redox Description Qu. Az. Cont. Color f^^/^ ^J oiV^ I^Je? f^-c Texture ~5U ~T^ _j_ Structure Gr.Sz. Sh. 7-CT^/AU~^~ Consistence ^i ^ y 0-}^ _mL_ Boundary ci$-^~ Roots T^T 3 ^. / t/f- Soil Application Rate GPD/Ft2 *Eff#1'7T~T •^ c *Ef?2~^ ~rv ~U7 CST Name (PleassPrint) ^ .^», , ,A'lT&nFr^} '?o Ikos^ Address 'Ro, Bo^ S'2-2- ^ ^^ "Rij^r 'a.'X £^S"^Z_ sign%^C"7^ Date Evaluation Conducted ,— t/ - 5 o --Z/5 CST Number •S.2.QQ€jO Telephone Number ^ ^ 7^5" 2.et2." ^(^(ft * Effluent #1 = BOD > 30 s 220 mg/L and TSS > 30 s 150 mg/L (^^j ^^o(j^^^W^) Effluent #2 = BOD, s 30 mg/L and TSS s 30 mg/L SBD-8330(R04/21)^60 ~ Soil ^^ , ^S)-S>^^^^vu-+- 5/ZliZ^ 3 Boring # D Boring I Pit cj-f rGround surface elev. / '•" ft. Page £- of Depth to limiting factor 'r^>S jn. / elev._ft. Horizon I ^ 3_ Depth In. ~DT^ b-n '7 -n Dominant Color Munsell /c^•^3(1 $-^^^^^ Redox Description Qu. Az. Cont. Color fJ'- ^e yjc, /^f f) 0 ^<_ Texture ^L L5 _j_ Structure Gr. Sz. Sh. (^^k 0 D Consistence A. /4-1 UrA/' ^ L ^•[^ Boundary c\s c,5 I, Roots ^^ _2.^L~FF Soil Application Rate GPD/Ft2 *Eff#1~T < 7 . 7 *Eff#2 T^~ /. ^- (.Z- w. Boring #D Boring D Pit Ground surface elev._-ft. im Depth totimtt.ing factor.Jn. / elev.__ft. Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Or. Sz. Sh. Consistence Boundary Roots Soil Application Rate GPD/Ft2 *Eff#1 *Eff#2 Boring #D Boring D pit Ground surface elev.Depth to limiting factor.Jn. / elev._ Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots Soil Application Rate GPD/Ft2 *Eff#1 *Eff#2 * Effluent #1 = BOD > 30 £ 220 mg/L and TSS > 30 s 150 mg/L * Effluent #2 = BOD, s 30 mg/L and TSS <. 30 mg/L -z ^€ ^ yj i ' l . •? 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BAYFIELD COUNTY CHECKLIST FOR CERTIFIED SOILTESTS Submit the Following (Use Permanent Ink):IEffi RIs I 0 Check List iii MAY ' 3/025 W 10 Index Page / Title Sheet (Optional) Bgyfieid Co. Zoning Dopt ' 13 Original Soil Evaluation Report (Submitted in Deed Holders Name - not prospective buyers) El Original Plot Plan a Cross Section Soil Profile Sheet (optional) D Additional Information (Warranty/Quit Claim Deed) (Optional) Soil Evaluation Report: (Include the following Information) El Parcel Identification Number (must be 23 digit Tax ID#) DO NOT USE 12 digit, they are no longer being used 0 Property Owner's Information (not prospective buyer's name) CZ] Property Location (Accurate Legal Description with Sec/Twp/Range) El Road Name (where driveway is/will be coming off of) 13 Floodplain Elevation, Flow Rate, Comments and Recommendations 0 Complete Soil Boring / Pit Information G2 Date Soil Evaluation was conducted 13 CST Name, Signature, Number, Address and Phone Number D *Date Stamp* Plot Plan: (Include the following information drawn to dimension or to scale) El Bench Mark (Description, Elevation and Location) 0 Contour Lines (Example = 98.0' ,96.0' ,94.0') Bl Pioperty Location (Sec/Twp/Range/, Accurate Legal Description) 13 Borings (Locations and Elevations) ^ Percent and Direction of Land Slope 0 Well Location (Including Neighboring Wells, if applicable) ri Location of Wetland Areas, Floodplain and Navigable Waters El Buildings, Driveways, and Structures (Location and Descriptions) St Location of Property Lines Ef Existing System Location IZT Address Number and Road Name [3 Current Surface Elevation of Wetlands and Navigable Waters ^ CST, Owner and Property Information North Arrow Fee: E] Certified Soil Tests - Review & Filing Fee . $ 50.00 u/forms/sanitary/checklist/checklistforcsts