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2 Wisconsin Department of Safety and Professional Services "f ) © 7 II Page'1 cof <br /> � <br /> Division of Industry Services Ll< <br /> C -�t!-s/ Ii l <br /> SOIL EVAL TIC N R4PRRT 6 2f7 <br /> p, s.' CountyzitA� <br /> In accordance with SPS 384-Wis:=Adm. Code ;L <br /> Attach complete site plan on paper not less than 8 1/2 x 11 inches in size.PlOn must iiHA A� T► <br /> but not limited to:vertical and horizontal reference point BM,direction and $�urnett it <br /> ( ) ercent ElaA�Service��gt.ir,-��'i c't-vac- 014 6 ' = 22/9Y <br /> scale or dimensions,north arrow,and location and distance to nearest road. • or-roev ..Z2._/77 <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)). � fik , I Y./9•24 <br /> Property Owner Property Location <br /> if/Lid, Ila 4 l<w to Govt.Lot y, <br /> 0 El <br /> /< S n T Gj/ N R /b E (or) W <br /> Property Owner's Mailing Address Lot# Block# Subd.Name or CSM# <br /> (°v f7/� /C der RIS ),at- 3 <br /> City State Zip Code Phone Number City ❑Village ®Town Nearest Road <br /> r�nl�ysoh Imp Ir-c7-3‘-c- I ( )_ I 1 s'1155 IC/ d , s le'," <br /> El New Construction Use: J Residential/Numberofbedrooms.d Code_derived design flow rate 3° 'GPD <br /> 0 Replacement ❑Public or commercial-Describe: <br /> Parent material .'/e.c�u 1 Or;C-0- <br /> Flood Plan elevation if applicable NM ft. <br /> General comments and recommendations: <br /> Sys e r.Y: 91•-5— <br /> 1 Boring# <br /> El Boring g; s 7 7Y <br /> El Pit Ground surface elev. ft. Depth to limiting factor in. <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 /> / 0 -e-l. 7s-az 3/� — ti lMS5/�`. <br /> *Eff#1 *Eff#2 <br /> m l G 3 3.�ri . � /, 6 <br /> 01 y-d6 7s tit? 1"/w <br /> i5 �rnS6/ i,, I 6 5 3cc 7 /, 6 <br /> 3 A4,-yo -7,.5-11)? "/G. s �,s'� <br /> LI S©-74 7,s "ill 379 ' 5 m / <br /> s �sG I _ t �T , -7 /, 6 <br /> Ij I Boring# 0 Boring Geo <br /> ©Pit Ground surface elev. ft. Depth to limiting factor >i°n. <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 /> / L7_ c/ 7,5Ml'Z J/d — /S /fr,s6k 14-v. 1 c S .3in , 7 /,6 <br /> ,.2 y- Ay -7.3''IR VI 1 Jlrisd/e '- ' 65 Seo a -7 /. 6 <br /> 3 d y- '9 7.s(-1r7 '44 — 5 [S 56_ <br /> y 5`y- Yo 7SyR -6711 _ .. l G 5 , `7 /, <br /> 3 65 LI - . 7 / <br /> *Effluent#1 =BOD,>30 s 220 mg/L and TSS>30 s 150 mg/L *Effluent#2=BOD,>30 s 220 mg/L and TSS>30"s 150 mg/L <br /> CST Name(Please Print) Sign re CST Number <br /> James .S Da141-e-15 SJ d7341a <br /> Address d 776 o f/w y 3.s— Dat Evaluation Conducted Telephone Number <br /> we.bs tee 1411 s'4 res y- /y — cAl 7/.5--8-G6—ei/.5--7 <br /> SBD-8330(R04/15) <br />