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Wisconsin Department of Safety and Professional Services Page of <br /> Division of Industry Services �'�` �'_ ///�/ <br /> SOIL EVALUATION REPORT <br /> In accordance with SPS 385,Wis. Adm. Code County <br /> Attach complete site plan on paper not less than 8 112 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 D1;f Jb_13-/S-6S6-olyGoo <br /> scale or dimensions,north arrow,and location and distance to nearest road. �3 .�?.BD <br /> Please print all information. Reviewed by Date <br /> Personal information you provide may be used for seconds purposes Privacy Law,s.15.04 1 m). �. • 6•�'D• Z/ <br /> Property Owner Property Location ❑ R1 <br /> O�►1 Vovi R tnedert Govt.Lot '/< V, S /3 T y1 N R /b E (or) W <br /> Property ty Owners Mailing Address Lot# Block# Subd.Name or CSM# <br /> U410 /CO( <br /> City State Zip Code Phone Number City V ©.Town Nearest Road <br /> 1���►G k I ey El 53-0 3� swiss <br /> /Zed FOX Tra i f' <br /> ❑New Construction Use:®Residential/Numberofbedrooms Code derived design flow rate 360 GPD <br /> © Replacement ❑Public or commercial-Describe: <br /> Parent material `rjG�Gr a I ('�i�t Flood Plan elevation if applicable P-/N ft. <br /> General comments and recommendations: q )*U <br /> ❑Boring <br /> ❑ Boring# cJ� v b <br /> ®Pit Ground surface elev. ft. Depth to limiting factor 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. <br /> *Eff#1. *Eff#2 <br /> a y- 4 7,s1R`'/ti �s ,.�sd�< < , ► G s co , -7 j, 6 <br /> 3 / - Ye .s-i/74 <br /> ® Boring# ®Boring <br /> ❑Pit Ground surface elev. ft. Depth to limiting factor 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. <br /> *Eff#1 *Eff#2 <br /> -7 5 7/7 �/� /S ; 7 J.6 <br /> Sc' 711 <br /> *Effluent#1 =BOD,>30 5 220 m /L and TSS>30 5150 mg/L *Effluent#2=BOD,>30 s 220 m /L and TSS>30 5 150 mg/L <br /> CST Name( lease Print) Signatu CST Number <br /> t5 vac v <br /> Address W 776n N y-�'S` Date valuation Conducted Telephone Number <br /> l v ��!3 --/0 I - --- >���- y/ -7 <br /> SBD-8330(R04/15) <br />