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Wisconsin Department of Safety and Professional Services <br /> Division of Industry Services <br /> SOIL EVALUATION REPORT_� �� Page_of_ <br /> in accordance with SPS 383,Wis. Adm. Code <br /> Attach complete site plan on paper not less than 8 1/2 x 11 inches in size.Plan must County A.-t^An'f� <br /> include,but not limited to:vertical and horizontal reference point(BM),direction and Parcel I.D.O 7-OA 0-31-90-/6-/`7-5- /-'S- <br /> percent <br /> .rpercent slope,scale ordimensions,north arrow,and location and distance to nearest road. ^3foo- o 9qoco <br /> Please print all information. Review b Date <br /> Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). /I Za� 7-LLD <br /> Property Owner Property Location 13 1Z <br /> ma✓'IL- <br /> Govt.Lot 1/4 1/4 S /9 T yQ N R /6 E(or)W <br /> Property Owner's Mailing Address Lot# Block# Subd. Name or CSM# <br /> ;70(0 94' 4 V e -311 1 /0 <br /> City State Zip Code Phone Number ity []Village JKTown Nearest Road Y1,1-/ <br /> 5t /hW 5Sl014 (691 )763 A0(v,? 1 pu Ic (A"d j ar k St <br /> nNew Construction UseEl Residential/Number of bedrooms Code derived design flow rate GPD <br /> nReplacement M Public or commercial-Describe: <br /> Parent material tnr laG/4- 1 f Flood Plain elevation if applicable <br /> General comments p- <br /> and recommendations: s�S- lCJ• y�7• I9S. (o/ 9�+ r� <br /> ❑ Boring# <br /> 11 Boring <br /> pq pit Ground surface elev. ft. Depth to limiting factor 5-q in. <br /> Soil Application Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF <br /> in. Munsell Qu.Sz. Cont.Calor Gr.Sz.Sh. 'Eff#1 I 'Eff#2 <br /> G 7.s-,I;Z 3/st !S /s»s6/C w, J C 5 -3 rti . -7 /, b <br /> (6-54 7syrZy/H - lFs awrs6)< vr+ I G' S Ca <br /> 3 Y-69 7,5-11? y/.? c'X o!S`s/z-/fr /FS al m 56/< 1 G S 01 ' -S- 1 40 <br /> 1/ c/_ 7 /d yR / F/is S'"02 .h M 6 K m v ', - - 3 <br /> © Boring# Boring <br /> 0 Pit Ground surface elev. 94 r 3 ft. Depth to limiting factor -5-fl in. <br /> Soil Application Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF <br /> in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 I 'Eff#2 <br /> 1 0- 6 7.5-Yiz 3/,L — I S /i.,s 6 /c <br /> r.-, CS / 6 <br /> 6-S`l 75`7/2 4/4 — /F 5 511k 1,, 1 6S Go 5- A O <br /> 3 S9-S-7 '7ShR `'13 C,tj5-`/AsIS' <br /> `I 57- 66 70 W? 6/ F/,< S-9r/2 -/, <br /> ' <br /> Effluent#1 =BOD >30<220 mg/L and TSS>30<150 mg1L Effluent#2=BODS<30 mg/L and TSS<30 mg/L <br /> CST Name (Please Print) Signature CST Number <br /> Jam- S / ex /-c /s -! / d73v <br /> Address V Date Evaluation Conducted Telephone Number <br /> J-77ole A--t �s w 6sfY, w;, 1�9 �- 36 I y/s_ 5i&16 - e1_1,.$,- 7 <br /> SBD-8330(807/13) <br />