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Wisconsin Department of Safety and Professional Services Page of
<br /> Division of Industry Services
<br /> CST-09
<br /> SOIL EVALUATION REPORT
<br /> In accordance with SPS 385,Wis. Adm. Code Countyfl
<br /> ,/
<br /> Attach complete site plan on paper not less than 8 1/2 x 11 inches in size.Plan must include, 1...50-0 v1 (/
<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.
<br /> p7-cola ,/-ilC %S-/�-S LS-).71)-v�'7S"G<'.�
<br /> Please print all information. -= i-wed`y /// Date
<br /> Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). 4 , ' I 1.�. 11/2,2
<br /> Property Owner Property Location 7 ❑ 1 f
<br /> Al, vl ElI�..Fsa� Govt.Lot Y< �1A S /3 T '/0 NI R /� E (or) W
<br /> Property Owner's Mailing Address Lot# Block# Subd.Name or CSM#
<br /> 4157l f�a�lFl12t9c�e1 7—R& .1U. 3P 'yCState Zip Code Phone Number ❑Ci
<br /> ty
<br /> I=1 Village Town Nearest Road
<br /> OA.v)�'�`�'z I iu2 Isz/ '3c� ( ( ) 1 I J��k- _
<br /> ❑ New Construction Use: Residential/Numberof bedrooms .3 Code derived design flow rate ' 5C 3PD
<br /> 0 Replacement ❑Public or commercial-Describe:
<br /> Parent material 6:/.c r.--f Q,,r fci- Flood Plan elevation if applicable'//n1 ft.
<br /> General comments and recommendations:
<br /> ;yi E A, 91(0
<br /> IBoring# ❑Boring
<br /> E]Pit Ground surface elev. ciy`Ift. Depth to limiting factor 7 74 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 /> / C7 Ll .7.51/2 3/A ^ *Eff#1 *Eff#2
<br /> If , frn jSic v.., 1 `s. _.3M _ ,-7 /, G
<br /> &/-30 7,..5-11R �'/ (GS ,(1,,.5! A frr, / G; 5 3( 2 _ , 5 / o
<br /> 3 7 -7....s-1-712 ti 23 ))175ii 7( / / a ,),I�7 57_ 7, 7 s`/R - 5 <7 i-6
<br /> ti
<br /> IF e dms4 k ii-, ► 1F s' /,0
<br /> 179, / ', Byte `73 / '/Li/ 14,-,
<br /> ei
<br /> I .). I Boring# ❑Boring
<br /> ©Pit Ground surface elev. cli' /ft. Depth to limiting factor 7 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 /> 7. �r%z 34 *Eff#1 *Eff#2
<br /> /3 /m A l Li., 1 45 3pn , 7 /,.E
<br /> -4 � 3L1 7,5-`ri? /,cJ 4<hSbit ,.-ti / L7-S 3cE, : . /, 03 )1 _
<br /> 5-) 73sVi? `'/y >.s ,7?4,3'6K 1 6- s ()I'll
<br /> Lf .5a- 71l 7,9'// /A/ /F.S },n75`G/4- fr.--, 1 _ /,
<br /> *Effluent#1 =BOD,>30 5 220 mg/L and TSS>30 5 150 mg/L *Effluent#2=BOD,>30 5 220 mg/L and TSS>30 5 150 mg/L
<br /> CST Nam lease Print) Signatur CST Number
<br /> 0 i-til ti'e Ve i4,.t/s vz,-, S �4j ,)734/v4 0
<br /> Address oi 774e !'ice ' 3-5 Date valuation Conducted Telephone Number
<br /> 1 Y,.4$/-6' Li-7 3-q 89 3 1/—e—al) /.f Y;e2//5 ?'
<br /> SBD-8330(R04/15)
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