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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 /> 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. 0'7-c),0-,,1-Z1 0-/C)-31"s/j .35 -O/_S/p c <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(�(m)). - 1��/ 15f I/ <br /> 2.3 <br /> Property Owner Property Location 0 El <br /> are,yl C y Csr/Sot., Govt.Lot Y. '/< S 3A T y 0 N R /6 E (or) W <br /> Property Owner's Mailing Address Lot# Block# Subd.Name or CSM# <br /> 30 off 7tre-c� i /` ve S I V.)s P,V g <br /> City State Zip Code Phone Number 0 City 0 Village ©Town Nearest Road )7 (p( <br /> -11-A.cy /IIN I I5-C79 I ( ) I I 04icIGv'1 f C,►•,rct., Sr <br /> 1 d <br /> El New Construction Use:[ r Residential/Numberofbedrooms 0/ Code derived design flow rate 3' GPD <br /> ❑Replacement 0 Public or commercial-Describe: <br /> Parent material gk C:i ti/ 1)f i l-` Flood Plan elevation If applicable /r. <br /> General comments and recofhmendations: <br /> Tail ►e r'f p/Ae ei7t a-,f- <br /> Boring <br /> / Boring# N Pit Ground surface elev. 6ft. 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 *Eff#2 <br /> 1 O z/ 7,5`1/7 7/d- / 55 <br /> /. & <br /> 3 <br /> �t �- 3* -'-'7s-y/7 wjy r S 7 /. <br /> -7G 73"yi7 S/ter S ; 7 /, 6 <br /> ❑Boring <br /> Boring# <br /> 0 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/Ftz <br /> In. Munsell Qu.Az.Cont.Color Gr.Sz.Sh. <br /> 7. <br /> *Effluent#1 =BOD,>30 5 220 mg/L and TSS>30 s 150 mg/L *Effluent#2=SOD,>30 5 220 mg/L and TSS>30 5 150 mg/L <br /> CST lyame(Please Print) �� Sig ure /�' CST Number <br /> Address "77(o U u- 3 S D' e Evaluation Conducted Telephone Number <br /> u,-e s - s` * y- s -- 3 7,s %4- '/5 7 <br /> SBD-8330(R04/15) <br />