Laserfiche WebLink
Wisconsin Department of Safety and Professional Services <br /> Division of Industry Services <br /> SOIL EVALUATION REP T Page_of_ <br /> in accordance with SPS 383,Wis. Adm. Code <br /> County <br /> Attach complete site plan on paper not less than 8 112 x 11 inches in size.Plan must r-v r) e <br /> tIL- <br /> include,but not limited to:vertical and horizontal reference point(BM),direction and Parcel I.D.07- OA-5--d-Yo-!L!-SOS-S <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. /S-.S-76 0 d voo 0 <br /> Please print all information. Rev' d by Date <br /> Personal information you provide maybe used for secondary purposes(Privacy Law,s.15.04(1)(m)). ili LI/4- l5/ —Z2- X <br /> Property Owner Property Location GG <br /> 1(y i� � ✓-e--e flyo r� Govt.Lot 1/4 114 S 5 T z/� N R / 7 V9 <br /> Property Owner's Mailing Address Lot# Block# Subd. Name or CSM# <br /> /00 J ZQ6 e"y-s way 3/l ? y <br /> City NCuI State Zip Code, 25 ti 7 7 Number ty E]Village Town Nearest Road al 6 p 9 <br /> �14 /v1. 'ke t- rn N15-3-0s�i ( 7) n <br /> Sld /fir v� 2 /tel+e rl ��tJr <br /> New Construction Use[Z Residential/Number of bedrooms_._ _j— Code derived design Flow rate 3 C O GPD <br /> Replacement // Public or commercial-Describe: <br /> Parent material Flood Plain elevation if applicable _ ��/� fL <br /> General comments S/S l�`l <br /> and recommendations: /©Z1 C4, <br /> i❑ <br /> Boring# 11 Boring! <br /> Pit Ground surface elev. ft. Depth to limiting factor in. <br /> Soil—Application Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft <br /> in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 I 'Eff#2 <br /> o-H 7stirz-'/ /S /Ms6/4- r, I c �,1 7 I• <br /> 8- 7,s'1'A `/Y — !fS �rnsd l� yyt I G S 3c n cJ /, l7 <br /> 7 3y,7,# 7-5-y/? ��`/ Ps �s l• , ,, _ �+ + S` /. o <br /> Boring# n Boring <br /> 0 Pit Ground surface elev. '75, u ft. Depth to limiting factor '7)ft. <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 /> I - q - "y/?-,/r I is _7 I Co <br /> 40 7.S%/? " <br /> Effluent#1 =BODS>30<220 mg/L and TSS>30<150 mg/L Effluent#2=BOD,<30 mg1L and TSS<30 mg/L <br /> CST Name (Please Print) Si nature CST Number <br /> .JAw) rS /,gam , e /-5 � D.I.,14 j 73"/,f e) <br /> Address Date Evaluation Conducted Telephone Number <br /> �7-7(c? ' w�bs>4� � S`/853 !0~ 1 �l- /� �lS-SG �i x/157 <br /> SBD-8330(It07/13) <br />