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ITV <br /> C . t g 0 ;,-► c is 1 <br /> 'r` SEP 2 9 2023 <br /> `' Wisconsin Department of Safety and Professional Services <br /> lr 4: . ,, ,� Division of IndustryServices _ Page L of <br /> 1=l•:p.Sp ? L <br /> 1,y( ;F1;S.1d SOIL EVALUATI N REPS tCounty • <br /> -�Pi Land Services Dapartmmori <br /> �,,!y!L= In accordance with SPS 385, is.Adm.Cote Canty t <br /> 11— <br /> Attach complete site plan on paper not less than 8 1/2 x 11 inches inPlan must include, u 4N G but not limited to:vertical and horizontal reference point(BM),direction and percent slope, Parcel I.D. 0 f Z. OO 0 0 o <br /> scale or dimensions,north arrow,and location and distance to nearest road. yea 3�2 3 <br /> i�'J' v3q <br /> Please print all information. vie ed b <br /> Personal information you provide may be used for secondaryDa e <br /> purposes(Privacy Law,s. 15.04(1)(m)). I/O�Q/7 Z <br /> Property Owner {�2J <br /> TJ71 vo l l�� Property Location h..4+ 7- ❑ ,?1 <br /> 5G v 1 I /ON, ) W <br /> /q D trk�.-cJ O Govt.Lot NL 'A N�,,,, 'A S Ll T 37 N R 1B E(or) W Property Owner's Mailing Address <br /> Site Address or CSM and Lot 4: 4,1.. <br /> Z 1 /8 toDfex- ,a• e,, .• A.,' I-le ` r-..,.do / le fri ' <br /> City l State Zip Code Phone Number <br /> �RN��VUI�-� �JII�.� .S�87r0 (fie/�, )30 .ElCit' ElV"Ilage ®Town Nearest Road <br /> 1 <br /> EDNe onstruction Use! esidentiai/Numberofbedrooms <br /> Replacement E]Public or commercial—Describe: Code derived designflow rate VS-6 GPD <br /> Flood Plan elevation if applicable ft. <br /> Parent material <br /> General comments and recommendations: A 1 <br /> 1 I Boring ['Borin <br /> g Ground surface elev(a7 R-(t. r3 0 d s 3 <br /> Depth to limiting facto in,/elev. ft. <br /> Soil Application Rate <br /> Horizon Depth Dominant Color Redox Description I Texture Structure Consistence Boundary Roots GPD/Ft2 <br /> In. Munsell Qu.Az.Cont.Color Gr.Sz.Sh. <br /> / le� /OYti /)►—I I ', / �/w - K I/Y1i✓ s `E& I `Effr2 <br /> �- I$- 2-0 I/o7 . 73 ! -- 1 / a ateD - to I -8 <br /> 3 �l° jo 7 59 '1/4 I ,s 1 �' - 4 I •S <br /> m�bt�l - I . 2- 1 . 3 J <br /> I <br /> I I I I I <br /> I I I I I <br /> I <br /> a. Boring# [Poring 60 3• <br /> (ElPit Ground surface elev. ft. Depth to limiting factor in./elev. O/� 9 <br /> ft. <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots 1 Soil AG IicatioPD/Ft n Rate <br /> In. Munsell Qu.Az.Cont.Color Gr.Sz.Sh. <br /> a— 4 I/off''/Z _ 'Eff�i 'Efr 2 <br /> -3 17-ak 17.5: 4YAI I / I sb� �►+ as �,!' - 4 . g <br /> �j z�-�3 I S''1�-'yl. �`��' 3 I I �.,�,4ble- - q ,� Ail' . ktt . 4 <br /> 5� /8 C 477,,-„J6K- -- . z.. . 3 <br /> CS <br /> S.ame(Please Print) <br /> ature <br /> ot Go;i4� wlli <br /> ai ti S � nw, • CST Number <br /> ZZL872, <br /> Add ss <br /> Date : alu.(�.n Conducted Telephone Number ea • a. kvc-lc 1.,..", j''`t8.f3 `1-z8- 2.3 2/43- 9/ .13 8 S <br /> 'Effluent#1 =BOD>30 s 220 mg/L and TSS>30 s 150 mg/L 'Effluent#2=BCD,s 30 mg/L and TSS s 30 mg/L <br /> SBD-13330(R04/21) <br />