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Wisconsin Department of Safety and Professional Services <br /> Division of Industry Services <br /> SOIL EVALUATION REPORT Pageof <br /> in accordance with SPS 383,Wis. Adm. Code County! B gTT <br /> Attach complete site plan on paper not less than 8 112 x 11 inches in size.Plan must <br /> include,but not limited to:vertical and horizontal reference point(BM),direction and Pam I.D. O 7 O 6 / <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. <br /> Please print all information. Review Date <br /> Personal information you provide maybe used for secondary purposes(Privacy taw,s.15.04(1)(m)). 7-d&-17 <br /> . <br /> Property Owner Properly Location PC <br /> ,4 A)A) 'L S /[/i'1 CC) / Govt.Lot 114 114 S .5—T Vo N R ` 7®r)W <br /> Property Owners Mailing Address Lot# Block# Subd.Nar CSM# <br /> s due a &j <br /> City State Zip Code Phone Number ity 4vllage Nearest Road <br /> a� z- s O sl) �8�` �/0 ,J <br /> New Construction Usef4 Residential/Number of bedrooms m2 Code derived design flow rate GPD <br /> Replacement 13 Public o commercial-Describe: <br /> Parent material r I L`x f � Flood Plain elevation ifapplicable <br /> General comments <br /> and recommendations: <br /> Boring# Boring Pit Ground surface elev. 7t7,yft. Depth to limiting factor in. <br /> Soil Application Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDffR <br /> in. Munsell Qu.Sz. Cont.Cob! Gr.Sz.Sh. •Eff#1 I •Eff#2 <br /> ® Boring# 11 Boring <br /> ro Pit Ground surface elev.�_fk 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.Sz. Cont.Color Gr.Sz Sh_ •Eff#1 •EfF#2 <br /> EQfuent'#1 =SOD:>30:S 220 mg/L and TSS>30<150 mg/L `Effluent#2=BOD <30 mg(L and TSS :30 mg/L <br /> CST Name (Please Print) Signa a CST Number <br /> Wade Rufsholm -, 227691 <br /> Address Date Evaluation Conducted Telephone Number <br /> PO Box 514,Siren,Wl 54872 (715)349-7286 <br /> SBD-8330(R07/13) <br />