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<br /> Wisconsin Department of Safety and Professional Servicesc Paces_of
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<br /> Division of Industry Services C22- I 0 7 1 SEP 2 8 2022 -k, ,, %%
<br /> cJ SOIL E'AML ATION REPORT "1
<br /> In accordance with SPS 385,Wis.BhImet$@tfun*aunty .- rnett-
<br /> Attach complete site plan on paper not less than 8 1/2 x 11 inches in she.PIai 4i st�1gtf.j8 s Department
<br /> but not limited to:vertical and horizontal reference point(BM),direction and percent slope, P cel. D. 17- -SOS -O 0/
<br /> scale or dimensions,north arrow,and location and distance to nearest road. O � �'`'�-y0 ,�5
<br /> , / - 0)7 Coo
<br /> Please print all information. Rev ew by / Date
<br /> Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). • , / 0I„3/,2?
<br /> Property Owner Property Location / CI ff
<br /> J I,lie Ind h•er Govt.Lot ,2 % Y< S o,S-T Lf ) N R /7 E (or) W
<br /> Property Owner's Mailing Addres Lot# ' Block# Subd.Name or CSM#
<br /> /15)C °13rd PL N. Ir.)l P g7 377173
<br /> City State Zip Code Phone Number 0 City 0 Village Q Town Nearest Road F39 7
<br /> tnhp I' C—c v e I MN I s-53/! I ( ) I Lk.141011 ?f:l1 „<t
<br /> [A New Construction Use:[Residential/Numberof bedrooms 3 Code derived design flow rate`in GPD
<br /> ❑Replacement 0 Public or commercial-Describe: l
<br /> Parent material (A-ikf I a ( U�,; b.- Flood Plan elevation If applicable�//eft.
<br /> General comments and recommendations:
<br /> Sys. ekv 5,i.Sl 9.3,5 5 9. /
<br /> Boring# 0 Boring 3.b _
<br /> [ Pit Ground surface elev. ft. Depth to limiting factor-S i/ in.
<br /> Soil Application Rate
<br /> Horizon Depth Dominant Color Redox Description ' Texture Structure , Consistence Boundary Roots GPD/Ft�
<br /> In. Munsell Qu.Az.Cont.Color Gr.Sz.Sh. *Eff#1 *Eff#2
<br /> I G i-f 7,s't7 ?/� is ; jai 6:iC . ,Y, 1 S 3�n 7 /�
<br /> d r-3 7 3�r►7 4/� — I fS ,,t,,,54/r t., 1 G'S 3�a , S' /,o
<br /> 3 38-s�1 �.sti,� 4/Lill=5 dm /"t /h I Gs �tm , s� / o
<br /> [5ut- H 7 s Ii7 `>/y CA or reYe /'F f )/►,sd/� r►� i . . /0
<br /> •
<br /> 0 Boring Boring 2 Pit Ground surface elev. G`' ;3. Depth to limiting factor 6 7in.
<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 /> / a- Cy 7sy,23/., — /S /w►sb 14 AA 6 s 30-1 . 7 .AG
<br /> G-48 7.s''I/2H/� / 3 m�6%/' M ► 65 Ica , S' 1 0
<br /> 3 S-4.1 17,sy/? '77/7, /Es ,Amsi k ► — of ell , s- /, G
<br /> y (7- 76 757/?`/Y /=I /7 s- //=� �( /,,� 70 / - - , .S` /.e
<br /> *Effluent#1 =BOD,>30<_220 mg/L and TSS>30 5 150 mg/L *Effluent#2=BOD, >30 5 220 mg/L and TSS>30 s 150 mg/L
<br /> CST Name(Please Print)" Sign ure CST Number
<br /> 343
<br /> wt.c s .S lft N t S 41A 7- /)it a(73�/01 Cl
<br /> Address 73'IA 0 r 3 S^ Da Evaluation Conducted Telephone Number
<br /> W bs fr= w� �'2! 3 - -7' 7/S- 114, - ie/S 7
<br /> SBD-8330(R04/15)
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