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Wisconsin Department of Safety and Professional Services Page of
<br /> Division of Industry Services �5 t - a 2- 1-73
<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, l''• �� P
<br /> but not limited to:vertical and horizontal reference point(BM),direction and percent slope, Parcel I. ye ..1 if,�7�.�"j�''_"�0�,
<br /> scale or dimensions,north arrow,and location and distance to nearest road. 'o7-�d'a-� - d&e&a0
<br /> Please print all information. IsLijd by i �����2�
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<br /> Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)).
<br /> Property Owner ,� Property Location 2
<br /> Go,vy JA►'-.SOh Govt.Lot '% Y< S .7 T 90 N R `5/ E (orj W
<br /> Property Owner's Mailing Address Lot# , Block# Subd.Name or CSM#
<br /> c j0 / 6th St w. 6d _
<br /> City State Zip Code Phone Number ❑City ❑Village j Town ) arest Road
<br /> Prid✓ /k I/Y!N _I.s537) I ( ) I I Soi'f i$piK 1 f t►- -
<br /> Ezi New Construction Use:p Residential/Numberofbedrooms --- Code derived design flow rate /30 GPD 'A,4,5e bc,l fj,-, 71 w:-/et
<br /> ❑Replacement /1 El Public or ommercial-Describe:
<br /> Parent material G-[FC it-I Dr', f7 Flood Plan elevation if applicable ft.
<br /> General comments and recommendations:
<br /> Sys. elf..., 9,148
<br /> Boring# El Boring SG D ,7 A
<br /> ®Pit Ground surface elev. ft. Depth to limiting factor in.
<br /> • Soil Application Rate_
<br /> Horizon Depth Dominant Color Redox Description ' Texture Structure ; Consistence Boundary Roots .GPD/Ft2
<br /> In. Munsell Qu.Az.Cont.Color Gr.Sz.Sh. *Eff#1 *Eff#2
<br /> / -II �.s7��/ /s : s'4k' . ,r, t � , 7 /.
<br /> I` I-dt 0 � //7���/ � /S A mSJ f( v.,‘ I 'C f' 7 /i
<br /> 3 ,40-fo 7,Pi/?`//& -- i S )0,SO( ► Yee : 7 /• 6
<br /> •
<br /> Boring# 0 Boring 9 j,{ 7 7a
<br /> A ©Pit Ground surface elev. ft. Depth to limiting factor in.
<br /> Soil Application Rate
<br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/Ft2
<br /> In. Munsell Qu.Az.Cont.Color Gr.Sz.Sh. *Eff#1 *Eff#2
<br /> , 7
<br /> / a" Li 7.sti/13/ — i s /P.,,5.5/c 14„ I 5 s 3 /, E
<br /> �- /S 7S`li? �i/y — / mj4/c ,r. 1 s 3c
<br /> 3 /5- 'f$ 75Li/?4' _ /S ) �5S/e Y-. I , 5 3to , 7 /, 6
<br /> Li `l3 -7) Z.r'R 3-‘, �' os "A I — ,), iv-, , 7 /, 6
<br /> *Effluent#1 =BOD,>30 s 220 mg/L and TSS>30 5150 mg/L *Effluent#2=BOD,>30_<220 mg/L and TSS>30 s 150 mg/L
<br /> CST Name(Please Print iSi0n
<br /> atur CST Number
<br /> Address , 774 0 Nr`7 7�^ Date E luation Conducted Telephone Number
<br /> w �rt t�1 5-9 - ,/ - ;� 7/.s-- : l(a- '/(5- 7
<br /> SBD-8330(R04/15)
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