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HomeMy WebLinkAbout57-24^/^. Wisconsin Department of Safety and Professional Services Division of Industry Services <0 nA\ii^ SOIL EVALUATION REPORT':jK"(U)!^ •/ ' i '-' 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)). MAY f::n'/0^Page.-of_ County Parcel I.D. ^^r^(^_ r^^-t^ i^^^^ ^J7/5 Property Location A fsc^>^-l ', "i FT Govt. Lot &~ % %S /y T '/7NR ^ E (or)@ ler dU ^ 3 -h5 p z-v<^ Sp^^ c_e Property Owner's Mailing Address P_&. B o"/< ^ 2> Site Address or CSM and Lot #: lf,-7S~^C> LJ. r>^7-L^^--^ city- ^^ -^0 y\ -^.c c<-&^ State^r Zip CodeJTW7 Phone Number 2.4'2.-)?5Xo(3U D City D Village 1^ Town (-t^<y l^e-j Nearest Road (^J. X>-e*^P La ^•e I New Construction Use: 12 Residential/Numberof bedrooms -i- I Replacement . I_| Public or commercial - Describe: Parent material 6- i<:t€. < <lI "Tt I General comments and recommendations: Code derived designflow rate /.S.0 GPD Flood Plan elevation if applicable_ft. Boring #QBoring IPit Ground surface elev.ft.Depth to limiting factor ^90 „.in. / elev._ Horizon / ^ _^_ Depth In.^E^-?c> 30'cfC Dominant Color Munsell /o ° & i/y^ ^ m ^f^- s-1 Redox Description Qu. Az. Cont. Color /^Jc-/^<3 /iJtS> ^f /Jo A^<? Texture $^^ ^_ Structure Gr. Sz. Sh. \^^ 0 0 Consistence H/t v-f-^- mL mL Boundary <-$ c^ Roots 3^o 2^ / ^^- Soil Application Rate GPD/Ft2 *Eff#1~T .-•7 .-7 *Eff#2 ,*7~TVTV z Boring #QBoring c?-**?Ground surface elev. ~//'l-ti.Depth to limiting factor.:'^.in. / elev.__ft. Horizon T 2- 3_ Depth In. ~0^~ ^zT 7-Ts- Dominant Color Munsell i^l^s/1 7.srri^i/^ $,-yp- b-1^ Redox Description Qu. Az. Cont. Color /^/o/l/^ ^Jo/^<L ;<J pA/f Texture St- L-S 3 Structure Gr. Sz. Sh. /^ i k f^i^ D Consistence -^L V-d/' M. i/-Fi^ <^<^ Boundary ^^^ Roots 36o 3 ^i7ZE Soil Application Rate GPD/Ft2 *Ef»17T _z_ .-7 *Eff#2 .r 1. (ftZ£ CSTMame (Please.Print);^ ..^ , ,T&n'r'T^} To Ik.^^ Address 'go. BQ'A S 2-2. ^yc.^ R<iW'uU^ S~¥f¥7 si9nature^^G-?—^<r Date Evaluation Conductgd•^-z:^-^' CST Number ZZoo<?0 Telephone Number7/5'"'ZY2-- ^-l^{ * 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 SBD-8330(R04/21) Boring # 0 Boring @ Pit Ground surface elev._/,_/ • -' ft. i-'a.ge C. of fffl.Depth to limiting factor '^'W in. / elev___ft. Horizon J_ ^- ^_ Depth In. ~^T~ f^2S ^-^ Dominant Color Munsell ^^^•z/L S"C^ ^<ft s-r/^ si^ Redox Description Qu. Az. Cont. Color ^J & ^e ^J & /AJ€ 1- c. •v<? Texture $L- LS> s Structure Gr.Sz. Sh. /A^< 0 0 Consistence kl^. 1/-pl^ /W L- /V) Z- Boundary ci s ^5 Roots 3^ ^.1^\T^F Soil Application Rate GPD/Ft2 *Eff#1 ~n_ --7 . -7 *EfW2 -7 1-^T£ Boring #d Boring D Pit Ground surface elev..ft.Depth to limiting factor.in. / elev._ft. Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cant. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots Soil Application Rate GPD/Ft2 *EfW1 *Eff#2 Boring #D Boring D Pit Ground surface elev.._ft.Depth to limiting factor.in. / elev._ft. Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots Soil Application Rate GPD/Ft2 *Eff#1 *Eff#2 * Effluent #1 = BOD > 30 £ 220 mg/L and TSS > 30 < 150 mg/L * Effluent #2 = BOD, 5 30 mg/L and TSS s 30 mg/L ^ 0'6S^-yu»4-°t®n s ?</?€, O^t-e.? / e l?'83-^' ^£A§>S?1^° 1^1 3'9?c'p'.u,'s-i''se P'y'Q- ixq^.-r "e ^~v^e-fee-Hs- ycA«r?4.^?@e^ ^4-' •-ffn Qnic&fs.U £>e.e^ Lo.^e_ ^<L ^ -^ •s.p ft^ (^ u ®~^ ^u *~_^ cr ^ ,n> IS r- ^ i^ lv» 0 |0. ®"^f >' F>u\ E^- p> ^-TOftt n- -^ r»rs >-§tei^§^•<s s *^T?4^§S* (^^» !&'$ fr^-i-s°?'<?j^2j^^sj-^^^s !T^l ^'<S?iC u;f- ^' s 0_ y. p <LC p. ^.c ^•e ^^ ^ ^ 9^r -.&^ c ~h <ft^<A3S- s~&gt'^ i^Nl >3- ;^ ^-* (t.^^ ^ ••^ 3"^1;' ;^:Fii0;Ifl c"T i» 00••'< 0 0 ]S't^yf^5) ^£ <A?S- i'. •- ": '' :<; ?s ?•» s ^ ~~t)ij^i^§H^3o'&^ s» s c? <s "re' e©>.-^"^^<T^ w-s f ^~ S"~5> *n?idl^ijl.is? •r~i"".'' 0- 'IS- ^^^ en ~5> *«•»< '~ Ft'S^J'^ia1? £ ";' IJ rA"^^ '^•1_ li^. ^sj 5 sr^:".^lii-iiii^'i^^II^I^f^^sf^ <%:'?'r^.s^ c- o^C^SJ'^^ (6 S 8-. ..A^±l^!? 'J C?'Ti'^ ^- ^*" i-i 'l!.. s^!'1^?5?Il0-^- ^S~"s'•i^iI "§ ^ 'Nt BAYFIELD COUNTY CHECKLIST FOR CERTIFIED SOIL TESTS Submit the Following (Use Permanent Ink): E3 Check List 10 Index Page / Title Sheet (Optional) El Original Soil Evaluation Report (Submitted in Deed Holders Name - not prospective buyers) B} 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 13 Property Owner's Information (not prospective buyer's name) CZI Property Location (Accurate Legal Description with Sec/Twp/Range) El Road Name (where driveway is/will be coming off of) 0 Floodplain Elevation, Flow Rate, Comments and Recommendations 0 Complete Soil Boring / Pit Information 0 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) ^ Bench Mark (Description, Elevation and Location) 0 Contour Lines (Example = 98.0'/96.0794.0') El Pioperty Location (Sec/Twp/Range/, Accurate Legal Description) liZI Borings (Locations and Elevations) E] Percent and Direction of Land Slope 0 Well Location (Including Neighboring Wells, if applicable) 1^ Location of Wetland Areas, Floodplain and Navigable Waters \S Buildings, Driveways, and Structures (Location and Descriptions) E? Location of Property Lines EZf Existing System Location Ef Address Number and Road Name [3 Current Surface Elevation of Wetlands and Navigable Waters ^ CST, Owner and Property Information North Arrow Fee: SS Certified Soil Tests - Review &. Filing Fee $ 50.00 . u/forms/sanitary/checklist/checklistforcsts