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Wisconsin Department of Safety and Professional Services <br /> Division of Industry Services <br /> SOIL EVALUATION REPORT Paged— <br /> in <br /> age — <br /> inaccoNancewithSPS383,Ws. Adm. Cade -/ _ <br /> Attach wmplete site plan on paper not less than 8 1/2 x 11 inches in size.Plan must County p"~A<tr <br /> include,but not limited to:vertical and horizontal reference point(BM),direction and Parcel L D.09- nA 0-A-Yo-�6- -S <br /> percent slope,scale or dimensions,north arrow,and location and distance 0 nearest read. /S- 0/5'- "A3 one <br /> Please print all information. ReMewal by Date <br /> Personatmrormaeon you pmvlaa may he used for a Ondaw narnoaer(Povacy Law,a.is 04117(m)). 4,44/6, Q/4✓1U/+� 7 �/,` <br /> Property Owner Property Location <br /> C F a /it Govt.Lot 1A 1/4 5 J3 T yo N R /(e E❑(or© <br /> Property Owner's Mailing Address Lot# Block# SUbd.Name or CSM# <br /> 7.54 a /YY Z /ZB "!8 Z Atil XULMKf Suer, oR OPUS rn# <br /> Gry State Zip Code Phone Number ityVillage Town Nearest Road a�s9y <br /> Ivek5{« WL SN893 ( Oalc/Onr/ Rairr-z /7�(. <br /> New Construc0on Uldo Residential/Number of bedrooms 3 Cede derived design flow rate 450 GPD <br /> Replacementic or .mmmerd <br /> Publat-Descnbe' <br /> Parent material z / (] {n Floed Plain elevation if applicable r✓lrJ H. <br /> General comments <br /> and recommendations: Sy e. i <br /> Baring# <br /> Boring <br /> Q Pit Ground surface elev. 9,S .S B Depth to limiting factor > 83 in. <br /> Soil lica0on Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence BurundiRoots GPDHF <br /> in. Munsell Cu.Sz. Cont Color Gr.Sz.St. 'Eff#1 <br /> _y 7S'r 173/ — /S /, 6/C CS 3co -7 <br /> d q' /r( 7s9.t'Y/4 — /S ;I—t.4/C �., 1 G 3 3c0 7 <br /> -ti osL ,..., l G 5 310 , 7 1 /, 6 <br /> Z/ 38- S SY,Q '//v <br /> S` 1-837sY/7� <br /> Boning# ❑ Boring <br /> © Pit Ground,adoceelev. 99. 8 fl. Depth to limiting factor 97rY in. <br /> SW Application Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence BoundaryRoots GPD/ff <br /> in. Munsell Qu.Sz. Cant.Color Or,Sz.Sh. 'Eff#1 I 'EHp2 <br /> O- 4 Z8YrZ 9� — /J ..+ab/C .« / [J 3co • 7 /, ( <br /> a6k- / LS 73co . 7 /. 6 <br /> 3 /a- v4 7s:rra % s/G. osL s 3 7 /, 6. <br /> 9y s Sr+ti' `//q — S/L, o s G jG S Jai M . -7 1. 6 <br /> s S - 74 7s9d•'/Y -S/6.- o s G ,,,,, / — — -7 / 6 <br /> 'EHluent#1 =BOD >30<220mgli-and TSS�30_I 150mg/L 'Effluent#2=BOD,S <br /> _30 mfltL and TSS<30 pegL <br /> r <br /> FAA'ddress <br /> Name(Please Print) Signature Number <br /> Data Evaluation Conducted Telephone Number <br /> 77G0 N 3S h/e bsv.� GU-T .SYJS7 G -3o-/y 7/T- 9LL—Y/S7 <br /> SBD-9330(1107/13) <br />