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Wisconsin Department of Safety and Professional Services Page of <br /> Division of Industry Services <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, <br /> ii-urN V <br /> but not limited to:vertical and horizontal reference point(BM),direction and percent slope, P cel I D•)_HO�1S-LI-.�".-70 0`�1C.00 <br /> scale or dimensions,north arrow,and location and distance to nearest road. a <br /> Please print all information. Reviewed by Q Date <br /> Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). O <br /> Property Owner Property Location V El2 <br /> Mr, He v!1 1 h C Govt.Lot 'A Y< S j T ej'O N R /5 E (or) W <br /> Pr erty Owner's Mailing Address Lot# 3 i I Block# Subd.Name or CSM# <br /> CityState ZipCode Phone Number © A 77 <br /> IQ J I �� I�0�� 0City ❑Village ��f Town , Nearest Road , (j <br /> h v-el I..( ) I I�1' ct“ovi I $"yli lif C:e,.vt. <br /> v New Construction Use:I Residential/Numberof bedrooms / Code derived design flow rate /3`0 GPD <br /> ❑Replacement <br /> Parent material /r'�aG i �❑Public rori��commercial-Describe: <br /> Flood Plan elevation If applicable Nr . <br /> General comments and recommendations: �/S e I E,v c '1. <br /> I l I Boring# 0 Boring 97 s "7 744 <br /> - <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.S.h,. *Eff#1 *Eff#2 <br /> 1 0- 7 s-`1i7 3/ -- /� lms 61 . et, 1 e.S 3,� * 7 /, 6 <br /> f3-�3 ry 7.�y�Z''/'/ --- /S/dr )isb lc' I A ► 6=i 3C0 7 /Y �, <br /> 3 36'72 7s'rks/� 5/,.- s6 y., I .—/ /, 6. <br /> A I Boring# 0 Boring c 7,9 >7v <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/Ft'' <br /> In. Munsell Qu.Az.Cont.Color Gr.Sz.Sh. *Eff#1 F*Eff#2 <br /> 0-8 77 71?7 -- /5 /47s6/C M / CS Sin •7 /,6 <br /> 8-35 751n'Vy — is44 v )m56/4 rn l G'5 34-0 r 7 /4 6 <br /> 3 'v 741 Z57fl52 _ /s/6. 0 s i_. In I — )/v) 7 /.6 <br /> i <br /> I I <br /> *Effluent#1 =BOD,>30 s 220 mg/L and TSS>30 s 150 mg/L *Effluent#2=BOD,>30 5 220 mg/L and TSS>30 s 150 mg/L <br /> CST Name(Please Print) ,-.) Signa e i CST Number <br /> Juhif'S -f 1-'0')>°C/.S f() )73 J4 !, <br /> \ddress )77e 0 "-A '7 •rs" Da e Evaluation Conducted Telephone Number <br /> tii e4 fy. kvJ 5 5F3 9/7'-")) J . 666-- iis-7 <br /> SBD•8330(R04/15) <br />