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Wisconsin Department of Safety and Professional Services <br /> Division of Industry Services <br /> SOIL EVALUATION REPORT Page_of_ <br /> In accordance with SPS 383,WIs, Adm. Code -}{- <br /> County <br /> Attach complete site plan ve paper not less them reference <br /> z 11 inches Msize.Plan must <br /> include,but not limited to'.vertical and horizontal reference point(BM),direction and parcel LD.O 7 O o 07 qn/ <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. p5' 00A 0/7000 <br /> Please print all information. Reviewed by Data <br /> P¢rsonarudonoxronvoapr.m vrat,beoseaensei,ondenp.rpos=s(P-wyLaw.s.ts.v<(1)(mp. 00i /.✓ 1Ul'b�/N <br /> Property Owner Property Locatimal c ❑f�t� <br /> RN e- TAC o 6 So.J Gevt.Lot �? 1/4 Ila S,-) T�/D N R/� E(on W <br /> Property Owners Mailing Address Lot# Block# Subd.Nameor CSM# <br /> 72 <br /> City ,ate Zip Code Phone Number ^ty Village Town Nearest Road <br /> /t J�u� w.y sv53� ( 0A �N � Tao :;1- c J <br /> New ConaUuction UseS Residential/Number of bedrooms Code derived design flow rate GPD <br /> Replacement /I+ Public or 72ri raal-Descnbe I <br /> Parent material I_ 114-6 i f}/ ��'/ �7` Flood Plain elevation if applicable �Jf}" ft. <br /> General comments I''�P"ud Sy J 9G.T z <br /> and recommendations:comments <br /> P S Cun 6(zJ. <br /> JOW-/V--Hff <br /> csr-/y-3y <br /> Bonn # 1pI� <br /> g 11 Boring <br /> Id:Pit Ground surface elev. 94. Depth to limiting factor X76 in. <br /> Soil Applilwtion Rate <br /> Horizon Depth Dominant Calor Redox Description Texture Structure Consistence Boundary Roots GPDflf <br /> in. Munsell Ou.Se. Cont.Color Gr.Sz.Sh. 'EMI I 'EU2 <br /> Boring# Boring r <br /> Pit Ground surface elev. d fl. Depth to limiting factor in. <br /> Soil Application Rate <br /> Horizon Depth Dominant Color Redox Description Texture Stmcture Consistence Boundary Roots GPDRE <br /> in. Munsell pu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 'Eff#2 <br /> Effluent#1 =BOD,>30<220 al and TSS>30<150 al Effluent#2 BOD <W mglL and TSS 30 mgt <br /> CBT Name (Please Print , 5'ignatur CST Number <br /> Wade RuBhOIm a,f�� 227691 <br /> Address IDate Evaluation Conducted Telephone Number <br /> PO Box 514, Siren,WI 54872 �— (715)349-7286 <br /> . suo-anvpcwnp/ <br />