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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 1/2 x 11 inches in size.Plan must include, 13� #1 <br /> but not limited to:vertical and horizontal reference point(BM),direction and percent slope, Parcel I.D.D 7- G�,j-)-y 1--/(o--0-,r O <br /> scale or dimensions,north arrow,and location and distance to nearest road. 0041 O! pao '7_1 <br /> Please print all information. Reviewed by Date q <br /> Personal information you provide may be used for secondary purposes Privac Law,s.15.04 1 m . <br /> Property Owner Property Location <br /> L O-W r,:f h c e 8 e g K Govt.Lot el a--r1/, Y. S 13 T 411 N R /641 E (or) W <br /> Property Owner's Mailing Address Lot# Block# Subd.Name or CSM# <br /> r'ro w A eocd /zd- <br /> CitY� State Zip Code Phone Nyq�er ❑City ❑Village z❑Town Nearest Road <br /> hA/ �S /l 313 �2b;y 4wr35 jcwe.� i�c� <br /> New Construction Use:[ Residential/Numberof bedrooms_�Code derived design flow rate •3OnGPD <br /> ❑ Replacement ❑Public or commercial—Describe: <br /> Parent material C hic r ti Flood Plan elevation if applicable ti/A ft. <br /> General comments and recommendations: gym /e 7 <br /> Boring# ❑Boring U 7 _ <br /> ®Pit Ground surface elev. `'t ft. Depth to limiting factor s in. <br /> Soil Application Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/Ft2 <br /> In. Munsell Qu.Az.Cont.Color Gr.Sz.Sh. *Eff#1 *Eff#2 <br /> v-y 7,S'�1� i s 7 1, 6 <br /> 4, 30 7,-5-`fR `f/c1 1-S a2ms/jlC r►� t GS co 7 /,6 <br /> J dt VC 41 vi o� W is tilf►^ <br /> F�] <br /> Boring# ❑Boring y�7 <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/Ft2 <br /> In. Munsell Qu.Az.Cont.Color Gr.Sz.Sh. *Eff#1 *Eff#2 <br /> 7,SYR 3// — i1 /M36A, ,., ► C s Sin - 7 /, 6 <br /> 3 1 'Sa 7.S7iZ `�/y S d.5- w, I 65 ra, 46 <br /> LI s�,-7 6 -7..5 -rR siy — s a G 1 — - . 7 1. 6 <br /> *Effluent#1 =BOD,>30 5 220 m /L and TSS>30 5150 m /L *Effluent#2=BOD,>30 s 220 m /L and TSS>30 s 150 m /L <br /> CST Name(Please Print Signat a ���? CST 7��� U <br /> JeLp",-s S a.ti r e<5 <br /> Address )7?6 Y -�� Dat Evaluation Conducted Telephone Number <br /> l�eSsft G✓%s �/3 S=d, ► -i9 7IS--YiG- 41/s'7 <br /> SBD-8330(R04/15) <br />