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Wisconsin Department of Safety and Professional Services O R I G I N A L Page of <br /> Division of Industry Services <br /> 05T- <br /> / I / �� SOIL EVALUATION REPORT <br /> l In accordance with SPS 385,Wis. Adm. Code County 0 N e h 4.1--- <br /> Attach complete site plan on paper not less than 8 1/2 x 11 inches in size.Plan must include, <br /> but not limited to:vertical and horizontal reference point(BM),direction and percent slope, 0P rcel4-3_,p_(S-o7-So S-mos -0!ileo <br /> scale or dimensions,north arrow,and location and distance to nearest road. \ o(14°O <br /> Please print all information. Reviewed b f Date <br /> Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). (7-a0^(S' <br /> Property Owner Property Location 0 II <br /> 4 o C-r 04 Ko 41.5(N .tie- Govt.Lot 1/4 1/4 S 7 T 3 3 N R IS E (or) W <br /> Property Owner's Mailing Address Lot# Block# Subd.Name or CSM# <br /> 7-5-A, 13(-FL. Sr y a.3 <br /> City State Zip Code Phone Number 0 City 0 Village ®Town Nearest Road <br /> 4s. v y f urs I Pt CO I I ( i I IL, F. /tette 1 WI.i...e_ 1?,( <br /> p New Construction Use: Residential/Numberof bedrooms ,Z Code derived design flow rate 300GPD <br /> 0 Replacement 0 Public or commercial-Describe: <br /> /1"/71- <br /> Parent material ‘ iA r., 1 (.) -1>`4- Flood Plan elevation if applicable ft. <br /> General comments and recommendations: 3. S <br /> .5 yJ. <br /> ❑Boring <br /> / Boring# ®Pit Ground surface elev.TS-; ft. Depth to limiting factor G 0 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. *Eff#1 *Eff#2 <br /> ( O-8 7.51Z 3/j_ — /S /•r»5 /L .,,. ( G 5 7" ,7 l ., <br /> J. r- 4 0 1.3-0. '11/4. — /FS A oi)Pc- .w ( 4 S 1 Co . s— t, O <br /> 3 40_ 4 fl 7.r7( `+/(e ch,e 574s7f f(s _„..,5ti/c k,i ( — - . S- I, o <br /> Boring# ❑Boring �S <br /> ®Pit Ground surface elev. ft. Depth to limiting factor .S-6 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. *Eff#1 *Eff#2 <br /> / a- 7 7.S7r'3/f. — /5 /,.,,, s6/c k-, ( C S 3•'+ .7 /. 6 <br /> d 9. .r 7,S`fr?"y4 — //=$ ol.r6/c ,..., ( G 5 3 Co . 5- I. D <br /> 3 .r4- CA 7.S'IR L'/4 4.e s"M-71- /' s ol..,f 6/c I -- — s- /. o <br /> *Effluent#1 =BOD,>30 5 220 mg/L and TSS>30<-150 mg/L *Effluent#2=BOD,>30<-220 mg/L and TSS>30 5 150 mg/L <br /> CST Name(Please rint) Sig ture CST Number <br /> J�N. -c S/ ..wr�(5 .S o17347'04 ° <br /> Address to Evaluation Conducted Telephone Number <br /> 01 -77 40 ff,.0-y 33- 6-014-/8 7 5 cFGP-11/S7 <br /> fjt/e6.511.-- r/"'.- .5-1-t cF53 SBD-8330(R04/15) <br />