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Home My WebLink About43-25S?1 SOll TEST y<_ 1 ^ ^?V(»i»ij»;;..;/^I^&'! Wisconsin Department of Safety and Professional Services - -' ii Division of Industry Services SOIL EVALUATION REPORT.m ii! Page.-of_ 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 ,. • L^j k-e_ (-/»J • > Y"^ /^ County E^y-F^d Parcel I.D.^ ^ -^^ 3^-7 (p Property Location /W^/Q Date, J,.fft^t( ^ t^<-t Govt. Lot ^ ^ A)^'% S 53 T y'7 N R S" E(i Property Owper's Mailing Afldres;zl7W l^^'AddressT'aaS-/- id L/^-i'(f^'e^lO '^.U-th. LA K-S. City ^ •^ , n^i <^->. ^y H^lCil^] State l^YlH Zip Code^3^Phone Number^^^D City D Village ^ Town "^_ y o ,->. /S- 11 ^ -€- ^ Nearest Road ^4L, L^k-^ ^ I New Construction Use: 1X1 Residential/Numberof bedrooms _. ^-L [Replacement . |_| Public or qommercial - Describe: Parent material fy If-'tt. s «*, i "Tt I General comments and recommendations: Code derived designflow rate_GPD Flood Plan elevation if applicable_ft. Boring #[_| Boring iPit Ground surface elev,M. Oft.Depth to limiting factor -7'^In. / elev._ Horizon / -z- ^_ Depth In. ~^~T -/5 ^ -i 03 Dominant Color Munsell 7 <T yj^/i ^r& s-ftft ^^fL S~/f Redox Description Qu. Az. Cant. Color /U c-< /-L-'' < ^J r.' /Vg. U c-/v^ Texture s^ T5~ _s_ Structure Or.Sz. Sh. l-f^.ici^k a Consistence /H i/4-i^ ^ <J-t'/ 1^11- Boundary ^s ^s Roots 3^~SLEE Soil Application Rate GPD/Ft2 *Eff#1~T .7 -z- *Efffi21T 15--7T Boring #QBoring IPit Ground surface elev.:Ho^.Depth to limiting factor.z&./ elev.-ft. Horizon / -2- -^- Depth In. D-^ ^-[% /^-S3 Dominant Color Munsell -7. crf-j/l 7<6-r^^r\^ ^ Redox Description Qu. Az. Cont. Color /\J i)<^<Z /A/ c >v^> 1^1 c. ^e Texture ~?7- L$ _j_ Structure Gr. Sz. Sh. 1-^« 0 D Consistence k^i I/FK kVi L. n^L- Boundary Q^ _^s_ Roots J^~ z ^-i73; Soil Application Rate GPD/Ft2 *Eff#1 ~K. .7 .7 *Efffi2~^~TTZE CSTf^ame (Please.Print)^ ..^, ,,A'iT&nT-r^} "?o lk.^si€s Address P.O. Bc,'^ S'2-2. ^("••e.^ R<u'«.rt/U,X f^f'^'7 Signature^ ^/ ^r^. Jl ' Date Eyaluatjon Conducted-^^^_ CST Number ZZ.QQ€!O Telephone Number7^5" 2.^2.- ¥^S~(^ 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) Boring # Q Boring Pit Ground surface elev .^'0 ft.Depth to limiting factor_^f, Page .in. / elev._ of. -n. Horizon T •z- _3_ Depth In. D- 6 JT-/<" ]^l Dominant Color Munsell iQ^^W £>~r&^-/^ ^Y[J s~/^ Redox Description Qu. Az. Cont. Color fJ o /^r€ /^o.ve ^Jr.^'-C Texture ^L 2.S $ Structure Gr.Sz. Sh. y-^Ac .0 D Consistence YV\.\J{-^_ M^- wL. Boundary ^tS' ^-s- Roots ~^^ z^\~T^ Soil Application Rate GPD/Ft2 *Effff1~T -7^ _2_ *Effiff23EHZIS: Boring #D Boring D Pit Ground surface elev..-ft.Depth to limiting factor.Jn. / elev.__ft. Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cent. 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.in. / 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 £ 150 mg/L * Effluent #2 = BOD, < 30 mg/L and TSS s 30 mg/L ^ w ^- <^ C[ < " T <s r * 7 ^< t - 7 -^ ^ ^- s Ok s ^ . y u ^ 4 ' t « n e ^ ? < > & • O e ^ s . ' t t e li ? ^ f ?- • • ' " ' l? a ^ ? L ^6 p § | ^ - t o " < " C® ' 12 . 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S £ ^ I ? ? ^. & ~ ! > " 2 . ^ BAYFIELD COUNTY CHECKLIST FOR CERTIFIED SOIL TESTS Submit the Following (Use Permanent Ink): 0checkust _ „...,., I i©ii^ ra 10 Index Page / Title Sheet (Optional) Jrjj " ;: " E ^ El Original Soil Evaluation Report (Submitted in Deed Holders Name - not prospective buyefsy^ '/. b ,•;;:, liJ' El Original Plot Plan ;^'/%^ ^, 'J^^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) E2 Property Location (Accurate Legal Description with Sec/Twp/Range) EZi Road Name (where driveway is/will be coming off of) 13 Floodplain Elevation, Flow Rate, Comments and Recommendations 0 Complete Soil Boring / Pit Information 31 Date Soil Evaluation was conducted 13 CST Name, Signature, Number, Address and Phone Number a *Date Stamp* Plot Plan: (Include the following information drawn to dimension or to scale) @3 Bench Mark (Description, Elevation and Location) 0 Contour Lines (Example = 98.0' ,96.0' ,94.0') 0 Pioperty Location (Sec/Twp/Range/, Accurate Legal Description) E] Borings (Locations and Elevations) 23 Percent and Direction of Land Slope 0 Well Location (Including Neighboring Wells, if applicable) 6 Location of Wetland Areas, Floodplain and Navigable Waters 3] Buildings, Driveways, and Structures (Location and Descriptions) ^ Location of Property Lines Ef Existing System Location 0 Address Number and Road Name Ei Current Surface Elevation of Wetlands and Navigable Waters @1 CST, Owner and Property Information North Arrow Fee: El Certified Soil Tests - Review & Filing Fee . $ 50.00 . u/forms/sanitary/checklist/checklistforcsts