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Wisconsin Department of Safety and Professional Services Page of <br /> Division of Indus*Services Cyr —�Lj�.2// <br /> SOIL EVALUATION REPORT <br /> In accordance with SPS 385,Wis. Adm. Code Count j <br /> Attach complete site plan on paper not less than 8 112 x 11 inches in size.Plan must include, I a f n e—r <br /> but not limited to:vertical and horizontal reference point(BM),direction and percent slope, Parcel I.DO7 O/d—a—y0^/S <br /> scale or dimensions,north arrow,and location and distance to nearest road. O��toca Sg� <br /> Please print all information. Reviewed b Date <br /> Personal information you provide may be used for seconds purposes Pdvac Law,s.15.04 1 m . •3r� ?j <br /> Property Owner Property Location <br /> c 1 /y` l s D h Govt.Lot I d-d '� '� S T yQ N R /,s E (or) W <br /> PropeEl <br /> rty Owner s Mailing Address Lot# 9 Block# Subd.Name or CSM# M�f <br /> 9741 Cl le Or / V,,S- /3J9y Als"'Y <br /> City State Zip Code Phone Number Ci 7.9.s7, <br /> Wee db�� 9 ty ❑Village Town Nearest Road <br /> �7J New Construction Use: Residential/Numberof bedrooms .3 Code derived design flow rate <br /> ,�(JGPD <br /> ❑ Replacement ❑Public or commercial—Describe:Parent material f La 1 11 l /,�„ ; F7` Flood Plan elevation if applicable 1-11�y it. <br /> General comments and recommendations: <br /> Boring# ❑Boring v � <br /> Pit Ground surface elev. g�' ft. Depth to limiting factor > <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. <br /> *Eff#1 *Eff#2 <br /> 17 <br /> co 7 <br /> 7rs <br /> sat- ?rS7ri y (v •S1lrr 01.l �+-� I 6 S l' �r <br /> D-1 Boring# ❑Boring q j <br /> ®Pit Ground surface elev. (y``fit. <br /> Depth to limiting factor > in. <br /> Soil A lication 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. <br /> *Eff#1 *Eff#2 <br /> s <br /> 8—3 6 jr'Ii2 <br /> —7, 5'r�? <br /> *Effluent#1 =BOD,>30 s 220 m /L and TSS>30 s 150 m /L *Effluent#2=BOD,>30 s 220 m /L and TSS>30 s 150 m /L <br /> CST Name(Please Print) figna re Numbera,.,cs73 y� 0 <br /> Address )7760 A/—y S— Evaluation ConductedE4Tjelephone Number <br /> �e -�y— do s=�G6- yes 7 <br /> TBD-8330(R04/15) <br />