Department of Safety and Professional Services Page of Division of Industry Services SOIL EVALUATION REPORT County In accordance with SPS 385, Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, Parcel I.D. 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. Reviewed by Date Please print all information. Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04(1)(m)). Property Owner Property Location Govt. Lot ¼ ¼ S T N R E (or) W Property Mailing Address # Block # Subd. Name or CSM# City State Zip Code Phone Number City Village Town Nearest Road ( ) New Construction Use: Residential / Number of bedrooms Code derived design flow rate GPD Replacement Public or commercial Describe: – Parent material Flood Plan elevation if applicable ft. General comments and recommendations: Boring Boring # Pit Ground surface elev. ft. to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/Ft2 In. Munsell Qu. Az. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 Boring Boring # Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/Ft2 In. Munsell Qu. Az. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BOD, > 30 220 mg/L and TSS > 30 150 mg/L * Effluent #2 = BOD, > 30 220 mg/L and TSS > 30 150 mg/L ≤ ≤ ≤ ≤ CST Name (Please Print) Signature CST Number Address Date Evaluation Conducted Telephone Number SBD-8330 (R04/15) Boring Boring # Pit Ground surface elev. ft. to limiting factor in.
Department of Safety and Professional Services Page of Division of Industry Services SOIL EVALUATION REPORT In accordance with SPS 385, Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 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. County Parcel I.D. Please print all information. Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04(1)(m)). Reviewed by Date Property Owner Property Location Govt. Lot ¼ ¼ S T N R E (or) W Property Mailing Address # Block # Subd. Name or CSM# City State Zip Code Phone Number City Village Town Nearest Road ( ) New Construction Use: Residential / Number of bedrooms Code derived design flow rate GPD Replacement Public or commercial – Describe: Parent material Flood Plan elevation if applicable ft. General comments and recommendations: Boring # Boring Pit Ground surface elev. ft. to limiting factor in. Soil Application Rate Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Ft2 *Eff#1 *Eff#2 Boring # Boring Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Ft2 *Eff#1 *Eff#2 * Effluent #1 = BOD, > 30 ≤ 220 mg/L and TSS > 30 ≤ 150 mg/L * Effluent #2 = BOD, > 30 ≤ 220 mg/L and TSS > 30 ≤ 150 mg/L CST Name (Please Print) Signature CST Number Address Date Evaluation Conducted Telephone Number SBD-8330 (R04/15) Boring # Boring Pit Ground surface elev. ft. to limiting factor in.
SBD8330%20Soil%20and%20Site%20Evaluation%20Fillable%20WORD.docx