HomeMy WebLinkAbout56-24CM-?
Wisconsin Department of Safety & Professional Services
Division of Industry Services
SOIL EVALUATION REPORT
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^•(^./V/.t^MA^/ii'A'Page_
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'^sv^SS^ ""' c"~ I" 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 A^-4-e/^
Parcel I.D. J^^7"T^< ?j ^^4 ? ^r)^t7
Reviewed by Date
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Property Owner
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Property Location
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Property Owner's Mailing Address
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Site Address or CSM and Lot #:-il7es' 5. 7^^'c^ ^<a^ .J^eL /<^~ 5
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ieCity, State, Zip
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Phone Number
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City
(^yka^i^D Village
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J3 Town l—u[:00 5Jearest Road
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D New Construction Use-Ml Residential / Number of bedrooms
Replacement D Public or commercial - Describe:
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General comments and recommendations:
J?Code derived designflow rate__^£&_GPD
Flood Plan elevation if applicable_ft.
L Boring #D Boring
EPit Ground surface elev. 'w'-^ f ft.Depth to limiting fact<in. / elev .^^.
Horizon
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Depth
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Dominant Color
Munsell
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Redox Description
Qu. Az. Cont. Color
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Texture
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Structure
Or. Sz. Sh.
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Consistence
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Boundary
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Roots
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Soil Application Rate
GPD/Ft2
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LC
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-z Boring #QBoring
Bjpit Ground surface elev./ / -W ft.Depth to limiting factor <~/ in. / elev.^fj^.
Horizon
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Depth
In.
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Dominant Color
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Redox Description
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Texture
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Structure
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Consistence
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Boundary
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Roots
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Soil Application Rate
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CST Name (Please Print)
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Address /f?t)C? /3a^dc. 50.^ D^''
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Date Evaluation Conducted
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CST Number
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Telephone Number
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* Effluent #1 = BOD > 30 <. 220 mg/L and TSS > 30 S 150 mg/L ' Effluent #2 = BOD, fi 30 mg/L and TSS & 30 mg/L
SBD-8330 (R03/22)
J Boring #
D Boring
0 Pit Ground surface elev<MMDepth
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n. / elev.^> • 6--ft.
Horizon
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Depth
In.
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Dominant Color
Munsell
Redox Description
Qu. Az. Cont. Color
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Texture
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Structure
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Consistence
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Boundary
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Roots
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Soil Application Rate
GPD/Ft2
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Boring #D Boring
D Pit Ground surface elev..Depth to limiting factor,Jn. / elev._
Horizon Depth
In.
Dominant Color
Munsetl
Redox Description
Qu. Az. Cont. 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
*Ef»1 *Eff»2
* Effluent #1 = BOD > 30 S 220 mg/L and TSS > 30 & 150 mg/L * Effluent #2 = BOD, s 30 mg/L and TSS s 30 mg/L
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BAYFIELD COUNTY
CHECKLIST FOR CERTIFIED SOIL TESTS
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Submit the Following (Use Permanent Ink):
D Check List
a Index Page / Title Sheet (Optional)
D Original Soil Evaluation Report (Submitted in Deed Holders Name - not 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)
B^Parcel Identification Number (must be 22_^igit Tax ID#) DO NOT USE 12 digit, they are no longer being used
ia'Property Owner's Information (not prospective buyer's name)
BTroperty Location (Accurate Legal Description with Sec/Twp/Range)
EfRoad Name (where driveway is/wili be coming off of)
CTFIoodplain Elevation, Flow Rate, Comments and Recommendations
B'Complete Soil Boring / Pit Information
CfDate Soil Evaluation was conducted
&C§f Name, Signature, Number, Address and Phone Number
a *Date Stamp*
Plot Plan: (Include the following information drawn to dimension or to scale)
B'Bench Mark (Description, Elevation and Location)
CTContour Lines (Example = 98.0796.0' ,94.0')
-CTProperty Location (Sec/Twp/Range/, Accurate Legal Description)
•CTBorings (Locations and Elevations)
Q15ercent and Direction of Land Slope
&-Well Location (Including Neighboring Wells, if applicable)
Q^bcation of Wetland Areas, Floodplain and Navigable Waters
B"l3uildings, Driveways, and Structures (Location and Descriptions)
B-tocation of Property Lines
Q-Existing System Location
B-Address Number and Road Name
G-eurrent Surface Elevation of Wetlands and Navigable Waters
B'fST, Owner and Property Information
IB-ISTorth Arrow
Fee:
E^ertified Soil Tests - Review & Filing Fee $ 50.00 U/forms/sanitary/checklist/checklistforcsts