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Wisconsin Department of Safety and Professional Services � Page of <br /> Division of Industry Services 1 --�� a <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, b <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. 0-7-0,19 _ =j� 93(,2— <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)). Lj• 1/V \ /,7• Z/ <br /> Property Owner / Property Location ❑ <br /> A 41,/G, p 6 u;t A P. Govt.Lot Y, Y< S 41 T 1/p N R j y E (or) W <br /> Property Owner's Mailing Address <br /> 77 Lot# Block# Subd.Name or CSM#City State Zip Code Phone Number ❑city /El ®Town Nearest Road <br /> /)H;ib Iv Y30 ) 5*zetf I ce Ad t2 <br /> ®New Construction Use:❑Residential/Numberof bedrooms Code derived design flow rate IS-0 GPD <br /> ❑ Replacement ❑Public or commercial—Describe: C�G v +S ,.s i f h f o i/e.•t- <br /> Parent material_ � Glt ( Z),-i FI Flood Plan elevation if applicable A1114 ft. <br /> General comments and recommendations: <br /> - .5ys �'l�v qa Es <br /> / Boring# ❑Boring <br /> ` ®Pit Ground surface elev.ys ft. Depth to limiting factor�yyin. <br /> Soil Application 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 /4 <br /> i f1- Y V 17,� '7 iZ`/ S os G r.► , G s >+'l . 7 /• 6 <br /> Boring# ❑Boring <br /> Pit Ground surface elev. ft. Depth to limiting factor in. <br /> W7 — <br /> Application <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots <br /> In. Munsell Qu.Az.Cont.Color Gr.Sz.Sh. <br /> r <br /> e-SO 75cl/I " 1, — S mSl� rvr I S —3 0- �0 7.6'11Z j/y — S osG l — <br /> *Effluent#1 =BOD,>30 s 220 m /L and TSS>30 s 150 mg/L *Effluent#2=BOD,>30 s 220 mg/L and TSS>30 s 150 m /L <br /> SST Name(Please Print) Signat a CST Number <br /> %ddress A77GO H- 7S <br /> j' Date valuation Conducted Telephone Numb r l' <br /> f/L' h 'ter S f 3 3 �)l �G� <br /> SBD-8330(R04/15) <br />