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Wisconsin Department of Safety and Professional Services <br /> Division of Industry Services <br /> SOIL EVALUATION REPORT Page ! of 8 <br /> in accordance with SPS 383,Wis. Adm. Code r I /S <br /> u r <br /> 7� <br /> Attach complete site plan on paper not less than 8 1/2 x 11 inches in size.Plan must County �e- <br /> include,but not limited to:vertical and horizontal reference point(BM),direction and Parcel I.D.o7- OdO-a. <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. <br /> Please print all information. Reviewed bb Date <br /> Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). Z8 4?nk <br /> Property Owner Property Location 17177 <br /> v R/C Govt.Lot 1/4 1/4 S p T q0 N R 16 E(or)W <br /> Property Owner's Mailing Address Lot#_ Block# Subd.Name or CSM# <br /> 17 6 X17 EN1tr /9vt EaSf y s ✓ 3 P. /Da <br /> City State Zip Code Phone Number City []Village Town Nearest Road 7717.? <br /> (�°`S�/•� /MIV iSSo;F3 I ( ) C'a/c/An'Ve U. <br /> nNew Construction Useg Residential/Number of bedrooms {jwrwT e Code derived design flow rate /✓`-� GPD <br /> 0 Replacement � ® Public or commercial-Describe: <br /> Parent material Al <br /> Flood Plain elevation <br /> //,-&if applicable / {(, <br /> General comments /{�. �/` / 9iC00 & O 16 ) <br /> and recommendations: Sy.S• 2 _/ l <br /> 25 39 C.46-Ae,,A&A a C.,, 1 <br /> ❑ Boring# <br /> 0 Boring <br /> Mr Pit Ground surface elev. ` ft. Depth to limiting factor > 7o�_in. <br /> Soil Application Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/f` <br /> in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 'Eff#2 <br /> /s /."sb/<, / l c s 3.•� -7 1, 6 <br /> Y^�O 7S�/zy /S ,f '40-06/< ,n f (S 3r , .7 /, 6 <br /> c- Y8. 7,S `/17 S e f G , t G 5 /F -7 1. 6 <br /> FT <br /> Boring# <br /> ® Boring <br /> Qpit Ground surface elev. ft. Depth to limiting factor in. <br /> Soil Application Rate <br /> HorizonWRedoxolor Redox Description Texture Structure Consistence Boundary Roots GPD/ftp <br /> Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 'Eff#2 <br /> / S4*1s6/e I cs 3m .7 /. 6 <br /> �Y — /.1 G� w�f6/< w/ / G 1 3 e0 7 1.4 1 <br /> may <br /> Effluent#1 =BOD >30<220 mg/L and TSS>30<150 mg/L Effluent#2=BOD,<30 mg/L and TSS<30 mg/L <br /> CST Name (Please Print) Si ature CST Number <br /> .lawrrS svGy/t/s f /�a- of 7.3voZd <br /> Address Date Evaluation Conducted Telephone Number <br /> SBD-8330(R07/13) <br />