Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)).
Property Owner Property Location
Govt. Lot 1/4 1/4 S T N R E (or) W
Property Owner’s Mailing Address Lot # Block # Subd. Name or CSM#
City Village Town Nearest Road
City State Zip Code Phone Number
( )
Wis. Dept. of Safety and Professional Services
Division of Safety and Buildings
SOIL EVALUATION REPORT
in accordance with SPS 385, Wis. Adm. Code
Page _____ of _____
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.
Reviewed by Date
CST Name (Please Print) Signature CST Number
Address Date Evaluation Conducted Telephone Number
Use: Residential / Number of bedrooms __________ Code derived design flow rate ___________________________ GPD
New Construction
Replacement Public or commercial - Describe: ___________________________________________________________________
Parent material ________________________________________________ Flood Plain elevation if applicable ______________________________ ft.
General comments
and recommendations:
* Effluent #1 = BOD
5
> 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD
5
< 30 mg/L and TSS < 30 mg/L
Depth to limiting factor __________ in.
Boring #
Boring
Ground surface elev. __________ ft.
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft
2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
Pit
Soil Application Rate
Depth to limiting factor __________ in.
Boring #
Boring
Ground surface elev. __________ ft.
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft
2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
Pit
Soil Application Rate
SBD-8330 (R11/11)
