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Wisconsin Department of Safety and Professional Services <br /> Division of Industry Services Page of <br /> SOIL EVALUATION REPORT <br /> In accordance with SPS 385,Wis. Adm. Code County <br /> Attach complete site plan on paper not less than 8 1/2 x 11 inches in size.Plan must include, `i y'r�°Y7° <br /> but not limited to:vertical and horizontal reference point(BM),direction and percent slope, Parcel .D. <br /> scale or dimensions,north arrow,and location and distance to nearest road. c 7-c r�. -'1 D-h-IC-S-/S-/A S- �73 c�o� <br /> Please print all information. ._ /vYed by/ 1 <br /> 111,Personal information you provide may be used for secondary /O Dat- <br /> Personal purposes(Privacy Law,s.15.04 1)m). � , �I'� ; <br /> Property Owner z: <br /> Property Location ❑ <br /> Ltirr / rkvt Go .Lot / / S 12 <br /> io T yO N R 1S- -E (or) W <br /> Property Owner's Mailing Address Lot#�LI Block# Subd.Name or CSM#?o I3ex 6 7 <br /> City State ZipCode Phone Number <br /> 0 Ci <br /> St Grb i x /'<-I/S tv sLic, 1 -ps-)63,6 <br /> 3s-t ty ❑Village ®.Towo-o Nearest Road .zvt <br /> • ;3 y y <br /> �I ct a14s �� ��� I iz <br /> © NewConstruction Use:©Residential/Numberofbedrooms 3 Code derived design flow rate 4 2GPD <br /> ❑ Replacement 0 Public or commercial-Describe: <br /> Parent material • Ice.r w I I7 r,.le7 5 ys. P Irv. 9�(Flood,Plan elevation If applicable N1/3ft. <br /> General comments and recommendations: <br /> • <br /> I i Boring# <br /> (,�❑Boring Q <br /> Pit • Ground surface elev.�4 n, Depth to limiting factor � <br /> I In. <br /> • <br /> Horizon Depth Dominant Color Redox Description ' Texture . Structure Consistence Boundary Roots . Soil .GPO/ t2 Rate <br /> • <br /> In. Munsell Qu.Az,Cont.Color Cr.Sz.Sh.. ®/FtZ <br /> • <br /> A N-moo 7.S-Vi? '1/4/ /6 <br /> S o.5G • 1 6 S yea <br /> SO 3 U �s 'ir ��y /. <br /> ... <br /> • ®r .1. <br /> ...... <br /> . . <br /> Borin <br /> 0 Boring# ❑ 9 �� ,r <br /> ElPit Ground surface elev.. ft. Depth to limitingfactor ��in. <br /> lorizon Depth Dominant Color Redox Description Texture Structure Consistence BoundaryRoots Soil Application-RateGPDFt2 <br /> In. Munsell Qu.Az,Cont.Color Cr,Sz.Sh. GPD/Ftz <br /> 1 0-zI s -/)? �� _ *Eff#1 IIEN <br /> IS" I fo a55 is inn J C,f 3 m <br /> /y -5 GSA <br /> 3 '/ -5'`/ 7,3-'0'%y .— s 65 61 f C s 3 v • /, 6 <br /> 11 <br /> I <br /> I <br /> *Effluent#1=BOD,>305 I <br /> 220 mg/L and TSS>30 51 I0 mg/L I *Effluent#2=BOD,>30 5 220 mg/L and TSS>30-5 <br /> dame(Please Print). Signatur 150 mg/L <br /> JG1-l11-zs — /� CST Number <br /> ;s ,A77642 T1ivy Y S :� 73 /�d . <br /> Date aluation Conducted <br /> -3 sir✓ Lv� .3-71 1C3 'I-)5',d 0 Telephone Number <br /> `7/s- G(•-y/S7 <br /> SBD-8330(R04/15) <br />