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• Wisconsin Department of Safety and Professional Services Page of <br /> Division of Industry Services <br /> SOIL EVALUATION REPORT <br /> In accordance with SPS 385,Wis. Adm. Code County /� <br /> Attach complete site plan on paper not less than 8 1/2 x 11 inches in size.Plan must include, C. c`t�1-7 <br /> but not limited to:vertical and horizontal reference point(BM),direction and percent slope, Parcel I.D. i�..1 4, •-Se�S-vt��-I-CI/t:YY` <br /> scale or dimensions,north arrow,and location and distance to nearest road. v 7-er.0-.`1P" <br /> Please print all information. vveew��by /// Date <br /> Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1gm)). 4 <br /> 4 I if!aa-.2 <br /> Property Owner I, Property Location j El 21 <br /> /3!c1N Prop. LL( Govt.Lot Li 1/4 1A S A . T ,ll) N R i6 E (or) W <br /> Property Owner's Mailing Address Lot# Block# Subd.Name or CSM# <br /> 17715 J011h5Cvi Lk- Ret se 4Ci•&s <br /> City State Zip Code Phone Number 0 City 0 Village ®Town Nearest Road ,l 7 7J(.5"" <br /> 0/-e b.5.4e.- I kir Js I ".J I ( ) I I Cie,kitolel I Jclt►,Jec, Lk.- /?6I _ <br /> ❑ New Construction Use:®Residential/Numberof bedrooms 1 Code derived design flow rate ?Ct.1 GPD <br /> ❑ Replacement 0 Public or commercial-Describe: <br /> Flood Plan elevation if applicable Lf..lift. <br /> Parent material (-I aC ICs I D rt c* , / <br /> General comments and recommendations: <br /> 1 Boring# ❑Boring <br /> ®Pit Ground surface elev. 99.3 ft. Depth to limiting factor >7 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 /> *Eff#1 *Eff#2 <br /> / G q 75' -V/ _ /-s- /0).3G x *-.-. / 3 r' , 7 / e <br /> ), y 34f 70-5tt22/iy -- /s ,l�,'5/i� <br /> Zvi / G, s drl _ , 7 / C <br /> Boring# ❑Boring <br /> 0 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 /> *Eff#1 *Eff#2 <br /> / __------------ ....---'--------- <br /> *Effluent#1 =BOD,>30 s 220 mg/L and TSS>30 s 150 mg/L *Effluent#2=BOD,>30<_220 mg/L and TSS>30 5 150 mg/L <br /> CST Name(Please Print) Signatur CST Number <br /> Jti.r»el. S /34/1 rt 6 E S 4c�73 1, 6 <br /> Address .A776 C //i , 3 3' <br /> Date luation Conducted✓� Telephone Number <br /> /V?43YYk- ws -5-7.1 tr 9 i 1j'--/3-- ), <br /> SBD-8330(R04/15) <br />