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Wisconsin Department of Safety and Professional Services _ Page of <br /> Division of Industry Services Cop - 35 <br /> SOIL EVALUATION REPORT <br /> In accordance with SPS 385,Wis. Adm. Code County )t <br /> Attach complete site plan on paper not less than 8 1/2 x 11 inches in size.Plan must include, <br /> but not limited to:vertical and horizontal reference point(BM),direction and percent slope, Parcel I,D 3 y._/�_�,5'_ /_0&0_0/,AC)00 <br /> scale or dimensions,north arrow,and location and distance to nearest road. C.?7-61y <br /> Please print all information. Reviewed by Date <br /> Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). tt ) A 4). 9 z� <br /> Property Owner Property Location <br /> MAff 9 C K Y'I~Vl Govt.Lot % % S T 39 N R Ik E (or) W <br /> Property Owner's Mailing Address Lot# Block# Subd.Name or CSM# <br /> to ilo y0 llte Nzt- <br /> City State Zip Code Phone Number 171 City ❑Village ®.Town Nearest Road <br /> +tip In IV -7cl ) h1� nevi ��>rtrS�H Rd <br /> New Construction Use:;3 Residential/Num berofbedrooms. 3—Code derived design flow rate z/3 o GPD <br /> ❑ Replacement ❑Public or commercial-Describe: <br /> Parent material l h(_t C- 1 l)e"f � Flood Plan elevation if applicable 0"M ft. <br /> General comments and recommendations: <br /> Boring# El Boring •c,/, <br /> 0 Pit Ground surface elev. ft. Depth to limiting factor 54V in. <br /> Soil Application Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots .GPD/Ftz <br /> In. Munsell Qu.Az.Cont.Color Gr.Sz.Sh. *Eff#1 *Eff#2 <br /> .5-0 7.5 y/Z U/ 1= 6/t "_'1 6: S 3 0 S' 4 6 <br /> 30- 60 7 5`I�Zy/4i G'� 7i? 3' Ivf=S sh lc F; , '-/ r✓ <br /> 1 I Boring# ❑Boring �b y <br /> r I Pit Ground surface elev. ft. Depth to limiting factor SJ�' in. <br /> Soil A lication Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/Fe <br /> In. Munsell Qu.Az.Cont.Color Gr.Sz.Sh. *Eff#1 *Eff#2 <br /> 7.5--11Z N I — 56A /, 0 <br /> .f 6-1,0 1 7,S7/7 '; J r P-R v s b/C <br /> *Effluent#1=BOD,>30 5 220 m /L and TSS>30 5 150 mg/L *Effluent#2=BOD,>30<_220 mg/L and TSS>30 5 150 m /L <br /> CST Name(Please Print) Signature CST Number <br /> u /I'Y_f 4) 1 _S 'J � A 73H-� o <br /> address )-1760 w y 33— Dat valuation Conducted Telephone Number <br /> wt j-fy Z: 3- ds- eA 1 7/5= 81�6- G//�7 <br /> SBD-8330(R04/15) <br />