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Wisconsin Department of Safety and Professional Services Page of <br /> Division of Industry Services C i i—at- S <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, "``' '�err <br /> scalebut ot orrmited to:dimens ons,rinorth arrow,andical and tal reference point location and distancM),ce to nearest road,on and percent slope, Parcel- 0.�4-,�e_is=3b-S 0S-Qc'a-ova IBC <br /> Please print all information. v'- edf // if Date / <br /> Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). WA ' /�/� I q�!?lr2/ <br /> Property Owner Property Location <br /> 7o1,,, Fr'.`-cis Govt.Lot +/, <br /> S jf;, T y 0 N R i 5- E (or) W <br /> Property Owner's Mailing Address Lot# Block# Subd.Name or CSM# <br /> �./S l reed /4v e I ;/, J. & i' ,),5 1 <br /> City State Zip CodeI Phone Number ❑City -7 S3 <br /> :�^/ i t'� I M n/ 1.�53.5 ❑Village ®Town Nearest Road d <br /> (_ ) I 13 ac..ie se IA I i i,c,r pJI..� Pe( <br /> New Construction Use:ID Residential/Numberofbedrooms 3 Code derived design flow rate 'IS-CGPD <br /> ❑ Replacement <br /> Parent material ❑Public1 or c/f t ommercial-Describe: <br /> I a i' /� Flood Plan elevation if applicable "t' ft. <br /> General comments and recommendations: <br /> 575 .e/-e. G 3, 7 <br /> I1 I Boring# 0 Boring 9 y <br /> El Ground surface elev. ft. Depth to limiting factor 5-6.. 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 /> , 5 /.e <br /> / a - 9 7.s�rR3/� _ <br /> a3 L1- 36 7s"Ir l/� <br /> j F S ri s b iz' rr, I 6- S 3" <br /> ni <br /> ll-s i4�SS rn1' . Li . 6 <br /> • <br /> d I Boring# <br /> ®0 Boring 94.' 7�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 /> I 0-L I 7,S y'/Z 3/l — l S .6-P?S b/e vl. / C 5 ?m . 7 /, to <br /> Li-Ye 7s-r17`,/ -- //s oT.-, 5AK <br /> 1s km36ic ► 5 ,c .h , -7 /, 6 <br /> `f 5)- -701, 75'712-74 — S 0S6 .-h I _ <br /> IF . 7 /. 6 <br /> *Effluent#1 =BOD,>30 5 220 mg/L and TSS>30 s 150 mg/L *Effluent#2=BOD,>30<_220 mg/L and TSS>30 5 150 mg/L <br /> CST Name(Please Print) Signatur S /� CSTr <br /> Address 77s 0 �k y 3s Date aluatidn Conducted Telephone Number <br /> w -Oa 5/ Y,- Wz .5"Z/ 1'73 7- 5-- ,I / 7/5= 3rrv(— 1//,5--7 <br /> SBD-8330(R04/15) <br />