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Wisconsin Department of Safety and Professional Services Page of <br /> Division of Industry Services C5T�21 -01 <br /> SOIL EVALUATION REPORT <br /> In accordance with SPS 385,Wis. Adm. Code County <br /> Attach complete site plan on paper not less than 81/2 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. <br /> scale or dimensions,north arrow,and location and distance to nearest road. .-0 <br /> Please print all information. Reviewed by Date <br /> Personal information you provide may be used for secondary purposes Priv Law,s.15.04 1 m . �' "`• S(r•2 J <br /> Property Owner Property Location <br /> A GaticilvVovL Lot '/, '/, S �� T �D N R E (or) W <br /> Property Owner's Mailing Address Lot# y Block# Subd. Name or CSM# <br /> Z�w • / <br /> city�4N�r Sate Zip Code's Phone Number 0 City ❑Village DO To t Road <br /> New Constnjction Use:W Residential/Numberofbedrooms Z Code derived design flow rate 0 GPD <br /> Uf Replacement raG0 Puc or c mmercial—Describe: <br /> Parent material ` 'r r Flood Plan elevation if applicable <br /> General comments and recommendations: <br /> Boring# ❑Boring(9Pit Ground surface elev.�ft. Depth to limiting factor 'q <br /> �in. <br /> Soil Application Rate <br /> Horizon Depth Dominant Color Redox Description WTexturee Structure Consistence Boundary Roots GPD/Ft2 <br /> In. Munsell Qu.Az.Cont.ColorGr.Sz.Sh. "Eff#1 `Eff#2 <br /> o-z , — rn C 1.�Z- Y y/ 5 O�7 6 -7 1. <br /> r ! G� �• <br /> i <br /> F-Z] Boring# Boring / <br /> ❑Pit Ground surface elev g7J ft. Depth to limiting factor in. <br /> Soil Application Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/Fi2 <br /> In. Munsell Qu.Az.Cont.Color Gr.Sz.Sh. 'Eff#1 I -Eff#2 <br /> 6- .tJ i- <br /> � -7 <br /> 7s �siy <br /> Effluent#1 =BOD,>30 5 220 mgfL and TSS>30 5150 m L 'Effluent#2=BOD,>305 220 L and TSS>30 s 150 m L <br /> CST Name(P�ri Signature /� 0007, CST Number �/gc <br /> Address Date Evaluation Conducted Z Telephone Number J <br /> SBD-8330(R04/15) <br />