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Wiscbnsin Department of D Pa ofy <br /> pa Safety and Professional Services hPage <br /> Division of Industry Services tJM �J 2021 <br /> SOIL EVALUATION P T <br /> In accordance with SPS 385,Wis. Ad . Co <br /> fButlatt�CtAttach complete site plan on paper not less than 8112 x 11 inches in size.Plan must incbut not limited to:vertical and horizontal reference point(BM),direction and percentslLa3�# / <br /> scale or dimensions,north arrow,and location and distance to nearest road. ?it/1-d <br /> Please print all information. Reviewed by '•1 Date/ <br /> Personal information you provide may be used for seconds u 1 purposes Priva Law,s.15.04 m . IN• 15, •V <br /> Property Owner Property Location <br /> �p car ,tl�i Govt.Lot %. '/. S / T �� N R / E (or) W <br /> Property Owner's Mang AAcjdress / / Lot# Block# bd.N�"'�j or CS <br /> Ci State Zip Code Phone Number ❑City ❑Village KTown Nearest Road <br /> fol", I SSA Lit✓ 'S /G t✓¢/ <br /> New Construction Use: Residential/Numberof bedrooms_,3_Code derived design flow rate /f--'VGPD <br /> ❑Replacement 4 P I �(commercial-Describe: <br /> Parent material 6(QC.`.t/ -r f'� Flood Plan elevation if applicable�f% <br /> General comments and recommendations: <br /> Boring# 16 Boring Q <br /> ❑Pit Ground surface elev. T Depth to limiting factor 7&in. <br /> Soil Application Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/Fe <br /> in/yrrMunsell Q. Az.Cont.Color Gr.Sz Sh. *Eff#1 'Eff#2 <br /> 5 .7 .( <br /> 7- 2 h <br /> / I Boring# ❑Boring <br /> Pit Ground surface elev. ft. Depth to limiting factor B 6 in. <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 /> S'7- 6 7 ,�5'/y �i L , 7 1.2 <br /> Effluent#1 =BOD,>30 s 220 and TSS>30 5150 m 'Effluent#2=BOD,>30 5 220 m L and TSS>30 5150 m <br /> glL <br /> CST Name(P Pri�►t�, / // Signature CST Number <br /> Address Date Evaluation Conducted4461 <br /> Telephone Number <br /> SBD-8330(R04/15) <br />