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Wisconsin Department of Safety and Professional Services Page of <br /> Division of Industry Services G✓�23 -J, <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, fc3feirc811 d_'!0 /6, 4.-S OS- e2o6,.(1>19000 <br /> scale or dimensions,north arrow,and location and distance to nearest road. <br /> Please print all information. R vviie�i,�"d IA ti Datte <br /> Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). 'Aar raf, 15"/jc/ 3 <br /> Property Owner Property Location 0 <br /> /CGtt RIG{/1 Govt.Lot '% % S on- T yC N R %(�. E (or) W <br /> Property Owner's Mailing Address Lot# Block# Subd.Name or CSM# <br /> PO ae 6,0 V.3 /'s) <br /> City State Zip Code Phone Number 0 City ❑Village ®Town Nearest Road 64/' <br /> Li,, c it 1 u r- I5-r;I,S3 I ( ) I I c^c k lun I Devils 4iC ;?'/. <br /> - <br /> 0 New Construction Use:1J Residential/Numberofbedrooms 1 Code derived design flow rate 300 GPD <br /> jI Replacement ❑Public or commercial-Describe: <br /> Parent material 6 I.ec i u ) /Jr i A Flood Plan elevation If applicable A���ft. <br /> General comments and recommendations: <br /> ❑Borin > 7y <br /> Boring# g `Jy•4 <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.Sh. *Eff#1 *Eff#2 <br /> / C.) `I 7-5-11,? 3/dL 1-.5- �..' C Ao slim . ,r 1 c s 3 , 7 /. 6 <br /> 0( it-A,f ?,s1t7f74/L1 i,.5 )wistiL M I Gs' ce , 7 / 6 <br /> '3 ;it-j ti ?Stir? "/(/ i-5 )110b /c , ) GS }m i 7 /, 6 <br /> y 5,1 7L ,7-.5-`7i7 571 f et*, ,M ► .- - , -7 6 6 <br /> CO <br /> i Boring# Boring ��4.® 7 71 <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/Ft2 <br /> In. Munsell Qu.Az.Cont.Color Gr.Sz.Sh. <br /> *Eff#1 *Eff#2 <br /> % o,Li 7,51•117 34 /S , • 7 4 6 <br /> 4 y- 3) 7.s-17i?4/At :s • 7 4 6 <br /> 3 .1- -5`0 "7.s"ri? `/G — /S , 7 / E <br /> `7� 7. <br /> 41 0- s-(i,7s/ — S ,7 / b <br /> *Effluent#1 =BOD,>30 5 220 mg/L and TSS>30 5 150 mg/L *Effluent#2=BOD,>30 5 220 mg/L and TSS>30 5 150 mg/L <br /> CST Name(Please Print) Si naturede, CST Number <br /> Address 77to 0 , -''- r- <br /> .?- 'date Evaluation Conducted Telephone Number <br /> t'l''/o / r V WI- 5 / ��)� - �� -7/sT ,376- 945"7 <br /> SBD•8330(R04/15) <br />