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Wisconsin Department of Safety and Professional Services Page of <br /> Division of Industry Services c •- PP --- <br /> SOIL EVALUATION REPORT <br /> In accordance with SPS 385,Wis. Adm. Code County y <br /> Attach complete site plan on paper not less than 81/2 x 11 inches in size.Plan must include, `� r <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. O7-012 l-4'/ ' • 6 y-dG,-OI/cOO <br /> Please print all information, by Date .�Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). 47:aed <br /> i ,- I i' <br /> Property Owner Property Location 0 <br /> Ky 'Neje Govt.Lot IF Ya 6 s'/ s ` T 4/ N R AT-E (or) W <br /> Property Owner's Mailingdress �/ Lot# Block# Subd.Name or CSM# <br /> 6870 Old <br /> CityState Zip Code Phone Number 0 City 0 Village Ds Town Nearest Road <br /> I1anrur IW I5'4136 I ( ) I 15 - '4 P I 04d3S" <br /> 0 New Construction Use:0 Residential/Numberof bedrooms Z Code derived design flow rate .30./GPD <br /> 3 Replacement / // 0 Public or mmercial-Describe: <br /> Parent material G(4C�`�t I 9I(`J Flood Plan elevation if applicable��ft. <br /> General comments and recommendations: <br /> Boring# 0 Boring 97 <br /> 4 Pit Ground surface elev. Ori. 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. 'Eff#1 'Efr#2 <br /> 1 0.5 74-1(7/2 L 4374k l71, e* pvi ., 1 <br /> Z 5-411 7,PIC*P ,171 G y I F . 7 ).. <br /> 3 till-B7 ZIVA , lam ,- 67 .7 ).6 <br /> Z•. Boring# 0 Boring / <br /> EPit Ground surface elev. 9L 6ft. 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 /> In. Munsell Qu.Az.Cont.Color Gr.Sz.Sh. sEt{#I *Eff#2 <br /> o-b 75y /,7 — /..� ---, - . 7 <br /> Z 6-77 1.e3r(y/y — , , 7 <br /> 'Effluent#1 =BOO,>30 S 220 mg/L and TSS>30 5150 mg/L *Effluent#2=BOO,>30 5 220 mg/L and TSS>30<_150 mg/L <br /> CST Name(Plop-se rint , Signature rie- ��i`l;;J! CST Number ��®15 /l <br /> Address Date Evaluation Conducted Telephone Number <br /> 68t�vw�i�v 4cv► *25:2 ?16:514-62-02-- <br /> SBD-8330 <br /> /551 -6zoZSBD-8330(R04/15) <br />