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Wisconsin Department of Safety and Professional Services Page of <br /> Division of Industry Services 'r-g g 41/vQ <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, N r <br /> but not limited to:vertical and horizontal reference point(BM),direction and percent slope, rc J.D. ..i/t �S S-c.5`-C'G'(--l 9 G&0' <br /> scale or dimensions,north arrow,and location and distance to nearest road. <br /> Please print all information. v" we by Date <br /> Personal information you provide may be used for secondary purposes(Privacy Law,S.15.04(1)(_m)). "rW^ 1,1 <br /> ' I$/6/2 <br /> Property Owner Property Location / ❑ <br /> IZI <br /> Re h S1,1/'6t vl S o ki Govt.Lot 1 Y. A S d S T 1C) N R 11 E (or) W <br /> Property Owner's Mailing Address Lot# Block# Subd.Name or CSM# 377/7e <br /> )i01 j,cot� 4Ve 3 v.d► P$7 <br /> City State Zip Code Phone Number 0 City 0 Village [21 Town Nearest Road 5?..3i101 <br /> (In+u,e(A. I wT I 5-4/8) 9 I ( ) I (AAA min _ PA ill- �� <br /> 133 NewConstruction Use:[2 Residential/Numberof bedrooms 3 Code derived design flow rate LOT GPD <br /> ❑ Replacement 0 Public or commercial-Describe: <br /> Parent material ('//t 1 u 1 /3,, i'' 1 N fg' <br /> Flood Plan elevation if applicable / ft, <br /> General comments and recommendations: e/e,j <br /> Boring# ❑Boring <br /> f Pit Ground surface elev. '5'Sft. Depth to limiting factor 7g°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 /> / <br /> y "7.S`'1/? 3i� — ` *Eff#1 *Eff#`2 <br /> d y I 7 S `t? `I/H — /f 5 el rl,S A�/ its ,Z ik,s hlc f� I 6 s )_.A. ,s- i. o <br /> 117 <br /> ,). Boring# 0 Boring <br /> ®Pit Ground surface elev.cis' ft. Depth to limiting factor 7 7in. <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 /> I ©- 9 '7is'Ii? 3/� --- (5 by,3✓, is 7*Eff#1 *Eff#2 <br /> J `i- 3 6 '7,S`in21/y --- / - _})rn56k p-, I 6.7 3e° ,5 1. 0 <br /> '3 34-Cc -7,5' In '`�/4. iris 1 Ill s 6 k in I C 51 Al►, _ , 5 /. 0 <br /> L/ 3-c-76 745 iiZ 9L — F5 0f6 ,_r, 1 _ — S- /. e <br /> *Effluent#1 =BOD,>30 5 220 mg/L and TSS>30 5 150 mg/L *Effluent#2=BOD,>30<_220 mg/L and TSS>30 5 150 mg/L <br /> CST Name(Please Print) Signatur ` CST Number <br /> Address ‘,/77 6 0 Nk-Y 35- Date E luation Conducted <br /> Telephone N tuber <br /> w.rb s-1,rr W.x 5-10i7 cl--/- dt4 `7/5--"'GI*- 1-f ,f l / <br /> SBD-8330(R04/15) <br />