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Wisconsin Department of Safety and Professional Services � ORIGINAL Page of <br /> Division of Industry Services Cs -- 11 <br /> SOIL EVALUATION REPORT <br /> In accordance with SPS 385,Wis. Adm. Code County l�v_(v.� <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. 07-0 32 •2-41/-15_2k[. 5 05-mg- 02/0c1O <br /> Please print all information, Reviewed by Date <br /> C <br /> Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). ...A 131 L2/20Z(7' <br /> Prouty Owner Property Location r/ ❑ a. <br /> V f r Govt.Lot D� Y4 V 6 Y. S ZY T y/ N R f 5— E (or) W <br /> Property Owners Mailing A ress`4 , Lot Block# S d.Name or CSM# <br /> Ci ` State Zip Code Phone Number ❑City ❑Village Town Neatest Roa ' ._.0 <br /> ' }J AAL U1 J S CZ I ()l5' ), I l 5-ra�S I f"`Yr( < _ <br /> 5? <br /> Er'NewConstruction Use:❑ Residential/Number of bedrooms ) Code derived design flow rate WDGPD <br /> ❑ Replacement Public or commercial-Describe: <br /> Parent material i /�, <br /> --��(A esti Q �,ot�$ Flood Plan elevation if applicable ft. <br /> General comments and recommendations: T' <br /> Ti61 Ib : 2i553 _ <br /> J Boring# Li Boring x <br /> ['Pit Ground surface elev. ./ ft. Depth to limiting factor 26 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 /> 2 (9-c 7,5 y' �/ /5 / I/9 ' CS `Ccn -7 <br /> �- 15 /'ich m/(( 3 3p^co •7 /•� <br /> ,3 3) . g,, 0,s y s6 s IAA 1 L..7 <br /> • <br /> Z Boring# ❑Boring !fro <br /> aPit Ground surface elev. f ft. Depth to limiting factor `Tj 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 /> z s qs- y % . 1 -/ cc �_ .� . t <br /> 44 <br /> .3 3)- 0,S r _ l (-..) 2-P l <br /> *Effluent#1 =BOD,>30 5 220 mg/L and TSS>30<_150 *Effluent#2=BOD,>30 5 220 mg/L and TSS>30 5 150 mg/L <br /> CST Name(Please Print) Signatur - CST Number <br /> Cory Jackson 824339 <br /> Address Date E uati ond�cted Telephone Number <br /> 24884 State Rd 35 Siren WI 54872 , _ Z 715 791 4768 <br /> SBD-8330(R04/15) <br />