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Wisconsin Department of Safety and Professional Services ,q.57!� Page of <br /> Division of Industry Services C.. - 2—2 2 Y <br /> SOIL EVALUATION REPORT <br /> R ` `� In accordance with SPS 385,Wis. Adm. Code County <br /> a\Y/c f pl on paper not less than 8 1/2 x 11 inches in size.Plan must include, t-' 0^n l <br /> but not lime ed o. al and horizontal reference point(BM),direction and percent slope, parcels _yi,/4-,3S-j"0S- 00 <br /> fc�- <br /> scale or dimensions,north arrow,and location and distance to nearest road. CI(6 CP'0 <br /> Please print all information. v w by Date <br /> Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). G i '//21/ _ <br /> Property Owner Property Location 0 E <br /> /e», f,.d Vey Govt.Lot % % S.W T 4// N R /6, E (or) W <br /> Property Owner's Mailing Address Lot# Block# Subd.Name or CSM# <br /> ��'( 8cy4 1H- 7 V. S P et7 <br /> City State Zip Code Phone Number 0 City 0 Village E Town Nearest Road c.J"/ <br /> I5 Li►'v1 $ v ; (Le j1, s C73`7 ( ) IsiAnss 1,0 ,n Peva Ze-nliny <br /> New Construction Use:12 Residential/Numberof bedrooms 3 Code derived design flow rate 45-0 GPD <br /> 0 Replacement 0 Public or commercial-Describe: <br /> Parent material 6fikelh I A.-.147 Flood Plan elevation If applicable/1'/g ft. <br /> General comments and recommendations: <br /> i,i /ev 9j j. 0 <br /> 1 Boring# 0 Boring G 7,1/. <br /> Pit Ground surface elev. Iy'7. Depth to limiting factor in. <br /> • Soil Application Rate <br /> Horizon Depth Dominant Color Redox Description • Texture Structure ; Consistence Boundary Roots GPD/Fib <br /> In. Munsell Qu.Az.Cont.Color Gr.Sz.Sh. *Eff#1 *Eff#2 <br /> / O - 9 .S% /? 3/� ors ti r rs ?in <br /> 6..,j if" iC .,5 //? "/`l /J (�✓i S�/� he.l 3 c+ /. <br /> `I /' `t 7 ciAj s' S G .•. 1 _ . 7 /. 6 <br /> Boring# ®Boring 9,y J. <br /> �. 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 /> ( c- 4 •7.3"-V)6_ — /S .7 / 6 <br /> •3 )2- f9 73---r % -- : 7 / 6 <br /> zi .ry- go -zsv% _S , 7 /, h <br /> *Effluent#1 =BOD,>30-<220 mg/L and TSS>30 s 150 mg/L *Effluent#2=BOD,>30-<220 mg/L and TSS>30 s 150 mg/L <br /> CST Name(Please Print) Signat CST Number <br /> Address /77‘G' /7�""'% 7� Date valuation Con ucted Telephone Number <br /> r�v-c Ss -• w1 S"5`3 %�s � 7'S:eE,- 9 - 7 <br /> SBD-8330(R04/15) <br />