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Wisconsin Department of Safety and Professional Services <br /> ORIGINAL <br /> Division of Industry Services <br /> SOIL EVALUATION REP/ORT Page of <br /> in accordance with SPS 383,Ws. AdmL. Code '7 <br /> County U a.r r , na- <br /> includ complete site plan on paper not less Nan 81/2 x 11 inches M size.Plan must <br /> include,but not slope. cleo to:veh ions,and horizontal reference point(BM),direction and parcel LpO�- moo- - - - .& <br /> percent slope.scale or dimensions,north arrow,andlocation antl distance to nearest road. Co.?—od000G <br /> Please print all information. Reviewed by Date <br /> Paraenal mmuuauouvou pmvme may oa used lorsecondarypmposeslPdvvcy Law,a,15 01(j)ha) LA'?111 1 1 <br /> Property Owner Property Location <br /> A( a ii 3C r GI Lot ,Y 1/4 1/4 s 3,f T� V0 N F,16E❑(or® <br /> Ad <br /> Property Owner's Mailing Address Lot# I Block# Sued.Name or CSM# <br /> �-r1Al No llo fJ Are 1-3 <br /> City State Zip <br /> Code Phone Number LFtty ❑tillage Town Nearest Roadd736,j <br /> J`/ l�ar" I mN SS//�/ (GSI) J7o 6853 pt/e/a of wGanYr>, 4er7/ <br /> New Construction Use Residential/Number of bedrooms_ i Code derived design flow rate 300 GPD <br /> Replacement Publicoroc sa ial-Describe: <br /> Parent material �/a Gtw( y .'{-/ Flood Plain elevation if applicable >/A fl. <br /> General comments 1, 5•`.83 f'p a(i <br /> and recommendations J. <�',V. <br /> ATC: naceaE 1Aj;7w& 2 Paas <br /> [. <br /> Bodng# Bodng <br /> ©' Pit Ground surface elev. 9S..f R. Depth to limiting factor in. <br /> sp7Xrp1whon Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP[_ DIS_ <br /> in. Munsell Qu.Sz. Cont.Color Gr.S,Sh. 'Effp1 `Eff#2 <br /> / e-6 7..r4l-?-/,t. /9 /..+s6/c <br /> d 6-/6 7.3-yi?+ — /FJ .„s5/G rut GS .3<0 <br /> 3 /G-yAS`77?� eddSYl? s%8 af ..able I .6" es /P <br /> /S r.JS If ,n J <br /> ® Boring# © Baring <br /> ❑ Pit Ground surface go, 9SS it Depth to limning factor_ 0 <br /> in. Soil A flwtion Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Concision: Boundary Roots GPD/lf <br /> in. Munsell Qu.Sz. Cont Calor Gr.Sz.Sh. 'Eff#1 'Eff#2 <br /> 0- 6 7, eI 3 — Is, .Z /b <br /> J, &— A07.3'Y/� � — ! . o <br /> 3 r �• N sYizv/� C sHl?-�E G �. .S <br /> 'Effluent#1 -BOD >30 a 220 mgll and TSS>30 s 150 mg/L 'Effluent#2=BOD <30 mglL and TSS<30 mglL <br /> CST Name (Please Print) Sgnatare CST Number <br /> jec S.L7a as, 15 Sl�a••-� 7 J 4,16 <br /> Address 47 Data Evaluation Conducted Telephone Number <br /> X7760 /�- 3.5— Iii Ky,> <br /> snD-8330dRa I3) <br />