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Wisconsin Department of Safety and Professional Services <br /> Division of Industry Services Page of <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 1/2 x 11 inches in size.Plan must include, 13ter'n{W- <br /> but not limited to:vertical and horizontal reference point(BM),direction and percent slope, Parcel I.D.scale or dimensions,north arrow,and location and distance to nearest road. -07-Oa- N/-/.S-�6~S05 -oo f' <br /> Please print all information. <br /> ie d Date <br /> Personal information ou provide may be used for seconds purposes Privacy Law,s,15.04(1)(m)). <br /> Property Owner �j�.31 , <br /> Property Location <br /> I►'IC Guire-l�a.n it ,j� �Rkc LL,G Govt.Lot V4 <br /> Property Owner's Mailing Address S T !j+/ N R �� E (or) W <br /> / I� A-1--'V rye f RN4�r Lot# Block# Subd.Name or CSM# <br /> City G� State ZipCode Phone Number <br /> ❑City El Village Town Nearest Road 39 <br /> Sim-[.r S G,t kes 0�;P e, <br /> FGeneral <br /> uction Use: Residential/Numberofbedrooms f Code derived design flow rate 9J-6 GPD <br /> ent ❑Public or commercial-Describe: <br /> G/e-eFlood Plan elevation if applicablents and recommendations: <br /> y 9A- 9 -QL C)A.t-� <br /> Boring# ❑Boring 'I N.y <br /> Pit Ground surface elev. �� <br /> ft• Depth to limiting factor � In. <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Bounds Roots Soil Application Rate <br /> In. Munsell Qu.Az.Cont.Color Gr.Sz.Sh, Boundary GPD/Ft2 <br /> S b/c-. /•. 7 Eff#� j 62 <br /> S <br /> Boring# ❑Boring Sy y <br /> Pit Ground surface elev. ft. Depth to limiting factor in. <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Bounds Roots Soil A l D/Ft n Rate <br /> In. Munsell Qu.Az.Cont.Color Gr.Sz.Sh. Boundary GPD/F' <br /> D~ 7,Syj? *Eff#1 *Eff#2 <br /> /e <br /> *Effluent#1=BOD,>30 s 220 m /L and TSS>30 s 150 m /L <br /> *Effluent#2=BOD,>30 s 220 m /L and TSS>30 s 150 m /L <br /> CST Name(Please Print) Signat re <br /> A� tis f/ �H 0—C (S. S J� CST Number <br /> Address /7700 7-r- Conducted ted 7W U <br /> D Evaluation Cond <br /> /N-e6Sfr i l,r J 89 � G_ � 9_� D Telephone Number <br /> SBD-8330(R04/15) <br />