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Home My WebLink About30-25Sft-00^ Wisconsin Department of Safety and Professional Services Division of Industry Services I I?© £ 3ZOZ5 ^(BSJ Hl{ P MAf -I SOIL EVALUATION REPC^d Cc. Zoning Dept lyjI-/Page icpt< j 50-o2 5 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 ^ C\\\^i5^~i ^ <-RO-^-STC UovJ county B^-F^I^ Parcel 1. D. ^— ^- ^ -c£ —> .^"""'' ^ Z1D -3'^~//5" Property Location Govt. Lot >-( 1/4 -/Yw/3 y< s Z^~T /7 N R <7 E (°^ 3rty Owner's Maillr^T7/UW^T'T^lueT-/- si-Site Address or CSM and Lot #: 72- "T'd<r.' *-\5 City ^(.a ^S ^-hie State L^JT Zip CodeJTYY^7 Phone Number(^i^a City , D Village IS Town 2. -7 ~>^^ cl [^Nearest Road Z_c(C€ A1!^'-^-6 k^i New Construction Parent material 6s-1 t-'i.c. i^i. Use: E3 Residential/Numberofbedrooms 2- Public or commercial - Describe:-n" 11 Code derived designflow rate -5'°0 ppp Flood Plan elevation if applicable_ft. General comments and recommendations: Boring #D Boring Ipit Ground surface elev,.l^Jt.Depth to limiting factor •^ilin. / elev. Horizon / ^ _3_ Depth In. o-H */-2.0 ZO-kV Dominant Color Munsell -?,^ 3/J^^^ ^ ^T^ S-_[j{_ Redox Description Qu, Az. Cont. Color /J ^^ /<i 0 /^ f A^ t, l\} € Texture $L ^5 j_ Structure Gr. Sz. Sh. /^^ 1^-^Y- _0 Consistence rv\^y t-Yl L- 1^1— Boundary ^5 c.5 Roots 5- ^^_7T" Soil Application Rate GPD/Ft2 *Eff#1~T .-7 . •? *Eff#2 .77ZF~7~V Boring #QBoring 1Pit Ground surface elev._ •7".Depth to limiting factor..in. / elev._-ft. Horizon I 2- 3- Depth In. ^D-^ <-^. ^-9^ Dominant Color Munsell io'i^^/L sr^P- 5l<p ^^_^R_ Redox Description Qu. Az. Cont. Color /J & ^ /Jo i^e {JD f^e Texture 5.L-T^~ $ Structure Or. Sz. Sh.?^ 0 D Conslstence ^L ^[^ i^n L- Boundary Ct $ cz5 Roots 3 ^ 3^ /I/T Soil Application Rate GPD/Ft2 *Eff#177- .7_ .-7 *Eff»2 .7 t.^77^ CST Mame (Please_Print).. 'I-'?"'\\&v\ (" lonj Address P.O. B&'A 'jr.y&v^ 'K.nu'^s.y ^ Y&L §•&.&. •u.X s~ ^.o5^6 ¥t^7 Signature /^? Date Evaluation ^ Conducted5-- o^t. ^- .A. ^J> CST Number •;1 Telephone Number •7^5" 2<£?2/- o o c^0 4-1 ^"6 * Effluent #1 = BOD > 30 s 220 mg/L and TSS > 30 s 150 mg/L * Effluent #2 = BOD, s 30 mg/L and TSS S 30 mg/L SBD-8330(R04/21)K^tw^*^)^|^^ ^;|T^ Page. Boring # D Boring Pit Ground surface elev,r^\-7~7^~ Depth to limiting factor__^_in. / elev.._ft. Horizon T -^ 3 Depth In. -^-77 /y^T Z\ -7S Dominant Color Munsell 5V& L(/^ s-rp. s'/^ c-/^" Redox Description Qu. Az. Cont. Color ^ c- <-J^ /^CT)^ p c> ,^f J^,// H^+- Texture L5 5 ' 1C. Structure Or. Sz. Sh. \^y^ a Consistence I^L /-H i— Boundary C5 Roots 7T73L Soil Application Rate GPD/Ft2 *Eff#1 . 7 . -7 *Eff#2 /. (fi. /.^ Boring #D Boring D Pit Ground surface elev._ft. i MAV Cie[$(h"(ojirn<tinc| factor _ Jn./elev. ft. Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Or.Sz. Sh. Consistence Boundary Roots Soil Application Rate GPD/Ft2 *Effff1 *Eff#2 Boring #D Boring D Pit Ground surface elev,-ft.Depth to limiting factor._in. / elev._ft. Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots Soil Application Rate GPD/Ft2 *Eff#1 *Eff#2 * Effluent #1 = BOD > 30 < 220 mg/L and TSS > 30 s 150 mg/L * Effluent #2 = BOD, & 30 mg/L and TSS s 30 mg/L V', -4-^ f (^ ~lc:7 ^1. ^\ -c:<-s^ -•<& ^ 0 ^ W ,5-^^1 .^Vw : •'.! ^/0 ^ 7} Ss ^fo ^^- ^ t"^T~^ 0 -^ t pc •T; & t-> ^ ? & -f-. ^ rr\ s" <^J3> ^.^'^< ^ J- .!^ \-, n— 0 c. ~T- ?~ rj -4- s. -<~^i SP r~ ? t> toc> ^ p< ^ p'~^'i^- ?'^ S'LS^-s. & 5- *.& ^tife •b 0&S€.i^y&4^'»i e >»'p€. O^s.'e I ° 8H;rPr?l •d''ss py?e-Qi>ca"i..;-.<-"f J?~o-l.»fWis' ^nf^^GQR/ ~Sw':~" e-fce.Sss-^ en^es.ssfi "& ??•<•f^^^~^-^ ^ S> 1,^- " "IN ^ "& So t-' t"' 1^ ^^1 ^{t-s.'" ?1 °^P.'Hr.^^^-1'^- ^s TT- tt»- ..^-^-^~ ^-u^ojr ^ H ^'CTrg< t& ^ = (A%5; ">?'y ? t? ^ -I l^k s.: ^ ^ ^^ K-_ (i ^ S ^ "0HITis 1.J^ y ? -? >5:?tf- ^ ^.^t-IS.w^p-^ yt t ce'p.--^" M. ' "^^r-^^y <srth ^®^~1^ ^ ¥ •? ^ n-^ \M ^n^^-tl^i^ltsjll§^€EM - f ^^.^ - =• —^ »^istt'§?t^r^ i^titii^i-^i ^?|E£^^^^Oll^lii?^-%'^¥rsJ ^, raF'5i~"J <c i ®-« of .•a^i A.9^ "-i!tfet*^ "11^ s asp'^HJi (S ©d 2-^.sllif 3"»§ jkl^ >w^l^2-;-|s "S^ f\SA ^'» A rj':^ ss 1 ^ ^^j»^;T ^ ^^'^?<^.st&lS^-s'.i5'l tii?5 &^sy.i-ilOtl-jf?^(^-^§ TT^J to'^A" j. ^^ '<s?^ u?6^ „ !;S»^. ® >l"i>*-tti~n- Ns? >»-~^ ViSo Or. ji^ys<& p''-$:< 1s ^f %-' 5 "y 5TH^ ; ^ ^0? i- +-I ??.°* <•c -<^^&» -€^f.^ ^"^ ' -<a'J*. tA "^Lt'-!-. ol BAYFIELD COUNTY CHECKLIST FOR CERTIFIED SOIL T^ Submit the Following (Use Permanent Ink): ^ r§ 1 Id? is i! I !i MAY i ;'.' W^ Bayfield Co. Zoning DeptEl Check List 10 Index Page / Title Sheet (Optional) El Original Soil Evaluation Report (Submitted in Deed Holders. Name - not prospective buyers) El 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) E 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) B Property Location (Accurate Legal Description with Sec/Twp/Range) El Road Name (where driveway is/will be coming off of) IZ1 Floodplain Elevation, Flow Rate, Comments and Recommendations @"i Complete Soil Boring / Pit Information El Date Soil Evaluation was conducted 12 CST Name, Signature, Number, Address and Phone Number D *Date Stamp* Plot Plan: (Include the following information drawn to dimension or to scale) 0 Bench Mark (Description, Elevation and Location) 0 Contour Lines (Example = 98.0',96.0',94.0') 12 Pioperty Location (Sec/Twp/Range/, Accurate Legal Description) El Borings (Locations and Elevations) fS Percent and Direction of Land Slope 0 Well Location (Including Neighboring Wells, if applicable) ^\ Location of Wetland Areas, Floodplain and Navigable Waters 0 Buildings, Driveways, and Structures (Location and Descriptions) El Location of Property Lines Ef Existing System Location El Address Number and Road Name [3 Current Surface Elevation of Wetlands and Navigable Waters [Z3 CST, Owner and Property Information North Arrow Fee: St Certified Soil Tests - Review &. Filing Fee . $ 50.00 . u/forms/sanitary/checklist/checklistforcsts