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• <br /> yS,- ltl'L, "• <br /> Wisconsin Department of Safety&Professional Services Page of <br /> i� ,'', Division of Industry Services <br /> =j' is �Y, <br /> C !s ,i SOIL EVALUATION REPORT <br /> Q �� In accordance with SPS 385,Wis.Adm.Code County Bur in e ±I. <br /> Attach complete site plan on paper not less than 8 1/2 x 11 inches in size.Plan must include, <br /> but not limited to vertical and horizontal reference point(BM),direction and percent slope, Parcel I.D. <br /> scale or dimensions,north arrow,and location and distance to nearest road. C7-01 a- -/'iO"15-13-5 15`v 6c-0I`�DOO <br /> Please print all information. iew d by Date I <br /> Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). Cti I7/II <br /> Property Owner Property Location Pa r o-P ❑ 0 <br /> A-c1 a j , WI'C1 el < c 0 yv be Govt.Lot 3 3/4 3/4 S 1 3 T 7 t3 N R 15 E(or) <br /> Property Owner's Mailing Address Site Address or CSM and Lot#: <br /> a g a S W Pn'r\c e'Fo n R-o-e- t-c).h, 3 cs rn L' 13 P . 1 y E <br /> City,State,Zip Phone Number ❑ City 0 Village 511 Town Nearest Road <br /> Pam C I co oe \/J S C 4"10 3 ( 7 I -g)a)N - 717 e/ .TGk_c2 5 0 n a4s 419 Bonne(Lake "kcd <br /> ❑New Construction Use:n Residential!Number of bedrooms_ Z Code derived designflow rate GPD <br /> 0 Replacement ❑Public or commercial-Describe: Flood Plan elevation if applicable 1\./A ft. <br /> Parent material G L)C-?(.l 'Ilisi-f <br /> General comments and recommendations: J -c-icc1' TxY1(1-1)1- '• Pow-Fs rvtr\e Pei t <br /> 1 Boring# ®Boring 7 7� <br /> ❑pit Ground surface elev��'9a ft. Depth to limiting factor, in./elev. ft. <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 /> .1 0- 5 7,sv � 3/a Is ar-il, oil I <br /> a c `70 7,5\IR Liiy — , 5rs , --,_ ---. z-t"m C,7 It6, <br /> ❑Boring <br /> Boring# <br /> ]Pit Ground surface elev. ft. Depth to limiting factor in./elev. ft. <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 /> CST Name(Please Print Signature CST Number 0`I 7 56, <br /> Address Date Evaluation Conducted Telephone Number <br /> 33c) ItAcLcf ft.1 ism )G id s 6t-tvi( io /- 1a.. 715- `t(0 3 -3 119 <br /> *Effluent#1 =BOD>30 5 220 mg(L and TSS>30 5150 mg/L. *Effluent#2=BOD,5 30 mglL and TSS 5 30 mg/L <br /> SBD-8330(R03/22) <br />