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!Nisconsin Department of Safety and Professional Services Page of <br /> Division of Industry Services G i- 21- <br /> r_ 41 _ <br /> SOIL EVALUATION REPORT <br /> In accordance with SPS 385,Wis. Mm. Code County <br /> g <br /> e#Attach complete site plan on paper not less than 81/2 x 11 inches in size.Plan must include, ��� <br /> but not limited to:vertical and horizontal reference point(BM),direction and percent slope, Parcel 1.D. <br /> scale or dimensions,north arrow,and location and distance,to nearest med. 07 j-7 f f- g-/A� • -007 <br /> Please print all information. - e./.,by /� Oates/ / <br /> 4Personal information you provide may be used for secondary purposes(Privacy Law.S.15.04(1)(m)). ' , / /� '�/7f <br /> , I •. <br /> iii <br /> Property Owner Property Location 0 <br /> fit <br /> 4€ iiiJ Govt.Lot Z. '/. 14 S / T ft N R /1/ E (or) W <br /> Property Owner's Mailing AdF WLot# Block# Sub am� CS � <br /> om, <br /> Ciy State Zip Code Phone Number 0 City 0 Village ®T Nea Road <br /> 'fk'ZONetAlie W I1 .I 4,5104I ( ) I I Topes <br /> I rj ralkZ <br /> 0 New Construction Use:I$Residential/Numberof bedrooms Z Code derived design flow rate 3CrobPD <br /> 54-Replacement L//' 0 Pu c or mercial-Describe: <br /> Parent material Matadi( M!.`F Flood Plan elevation if applicable Aafft <br /> General comments and recommendations: <br /> / Boring# 0 Boring Mir �i <br /> ( Pit Ground surface elev.7? ft. Depth to limiting factor 6 z 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. 'Etf#1 'Eff#2 <br /> Z 6-f9 75'`y2y/y f �t G -- :7 _ /..4 <br /> 3 3q-1Z 76r,P iq P1 !s /4 <br /> II I <br /> 2.1 <br /> Boring# 0 Boring [L <br /> at Pit Ground surface elev./76 ft. Depth to limiting factor 77 in. <br /> Soil Application Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/Ft2 <br /> tut. Munsell Qu.Az.Cont Color Gr.Sr..Sh. 'Eff#1 *Eff#2 <br /> I 0.6' 7.'3 /2 — L4 .-1 /t <br /> Z 5-'n 7yyikii -- S (. ------\._________ Th .7 /4 <br /> ia 7 1 712'411./ , • / 1_4 <br /> 'Effluent#1=BOD,>30 5 220 mg/L and TSS>30 51 0 mg/L 'Effluent#2=BOD,>30 5 220 mg/L and TSS>30 S 150 mg/L <br /> CST Name(P- .serint)._/ia � Signature / CST Number /qS <br /> Address frePe7 ��©© <br /> 688r Date Evaluation Conducted Telephone Number <br /> SBD-8330(R04/15) <br />