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Wisconsin Department of Safety and Professional Services <br /> Division of Industry Services ^ST r ai _ `-7 7 Page of <br /> SOIL EVALUATION REPORT <br /> In accordance with SPS 385,Wis. Adm. Code County <br /> Attach complete site plan on paper not less than 8 112 x 11 inches in size.Plan must include, <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. 07~ N <br /> Please print all information. Reviewed by Personal information ou provide ma be used for secondary ur oses Ea4tm).Properly Owner r� El R1 <br /> �! a Y< '/< S / T YV N <br /> Property Owners Mailing Address lock# Subd.Name or CSM# <br /> a1`�7�00� I-zd. <br /> City State Zip Code Phone Numbh 6"r k Y' Sti930Village ®Town Nearest Road e«74 <br /> Oalc/�hcP W. Yr/law I?lvrr /2�P <br /> FGeneral <br /> uction Use:0 Residential/Numberof bedrooms 3 Code derived design flow rate Lao GPD <br /> nt ❑Public or commercial—Describe: <br /> �r /oe i rA ( ��itCrt Flood Plan elevation if applicable iv/iqft. <br /> nts and recommendations: <br /> Sys- c/ev 94•d 4- 93. d <br /> Boring# ❑Boring Efls'oft. 7 7d <br /> El q <br /> Pit Ground surface elev. / <br /> Depth to limiting factor in. <br /> Soil A lication 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 /> 0- 1-4 7S y/2 J/a /S /�,-�s 6/c v►, l 5 3 *Eff#1 *Eff#2 <br /> a �, a� 7.s�►f� y�y -- .7 1. 4 <br /> S d s6& w, I s 3 F ."" /, 6 <br /> 1-0 7 5-yR 4' S o s G <br /> 1 I Boring# ❑Boring <br /> ©Pit Ground surface elev.�S ft. Depth to limiting factor 7�in. <br /> Soil A lication 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 /> o 7 S--n / *Eff#1 *Eff#2 <br /> 1,6 <br /> d ti� ao �sti�Z y/y is h,s.tir� t 6 s 3 r= <br /> �a- sy 7 57n 7 /, 6 <br /> asp �, ► s _ . ""7 /' 6 <br /> i <br /> 'Effluent#1 =BOD,>305 220 m /L and TSS>30 5 150 m /L 'Effluent#2=BOD,>30 5 220 m /L and TSS>30 5 150 m /L <br /> ST Name(Please Print) Signat CST Number <br /> J ng S /s l <br /> idress d 77�0 N�-r 3S' „z73 y� O <br /> Date aluation Conducted Telephone Number <br /> SBD-8330(R04(15) <br />