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Wis.Dept.of Safety and Professional Services SOIL EVALUATION REPO T page_of_ <br /> Division of Safety and Buildings <br /> in accordance with SPS 385,Ws. Adm. Code <br /> County ,/ve ;� <br /> Attach complete site plan on paper not less than 8 1/2 x 11 inches in size.Plan must <br /> include,but not limited to:vertical and horizontal reference point(BM),direction and Parcel LD. <br /> percent slope, scale or dimensions,north arrow,and location and distance to nearest road. obla 7L ?!`� pr01kD6 <br /> Please print all information. R Date <br /> Personal information you provide may be used for secondary purposes(Privacy Lmv,s_15.04(1)(m)). <br /> Property Owner / -1 Property Location <br /> AOrr� Wi-64 Govt Lot 114 114 S3ST 37 N R /� E tor)gD <br /> Property Qwner's Mailing Aggdress Lot# Block# Subd.NameV C*W <br /> 11 70 reg= 44 <br /> City State Zip Code Phone Number ❑City Qvivage M.Tovm Nearest Road <br /> / k- 4 112 l L <br /> ❑ New Construction user Residential/Number of bedrooms Code derived design flow rate `Jro-'�' GPD <br /> IKRepiacement ❑ Public or ro. ercial-Describe: <br /> Parent material MCA Flood Plain elevation if applicable ft. <br /> General comments <br /> and recommendations: <br /> ❑ <br /> Boring Baring <br /> # t -7q <br /> toJ pit Ground surface eiev. 97y ft. Depth to Funning factor 7 C ! in. <br /> Soil Application Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft 2 <br /> in. Munsell Qu.Sz. Cant Color Gr.Sz.Sh. ff#1 ff#2 <br /> 4O-Y ---- rl L G VF <br /> 2 Boring# ❑ Boring <br /> Pit Ground surface elev. ft. Depth to limiting factor 2(—in. <br /> Soil Application Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary hoots GPD1ft z <br /> in. Munsell Qu.Sz. Cont.Color Gr.Sz Sh. ' rt#1 02 <br /> ee7I <br /> Z y'-'qo Q A e7le7 G IvF 7 <br /> y6-76 7 G •7 1-2 <br /> 'Effluent#1=BOD <>30<220 mg1L and TSS>30 <150 mg1L 'Effluent#2=BDD s<30 mgtL and TSS <30 mg1L <br /> CST Na &/ P &- Signature r/ST mber <br /> f� <br /> Address V' J f Date Evaluation Conducted Telephone Number <br /> Z722a �4ri1��onrl�y G�(e�g�cr �,1,' S'�Bq �%D-/� 7r5�5'66-ozaZ <br /> SBD-8330(Rl Ill 1) <br />