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• <br /> 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 j-) <br /> Attach complete site plan on paper not less than 8 1/2 x 11 inches in size.Plan must include, vii <br /> but not limited to:vertical and horizontal reference point(BM),direction and percent slope, Parcel I _9/-/t.._3s 5 /S 35 1 <br /> scale or dimensions,north arrow,and location and distance to nearest road. 37-0.-v-- 037 coo <br /> Please print all information. Rev'ewed by Da e <br /> Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)m)). / A !^ 'j j // 5 <br /> Property Owner / Property Location ii <br /> /'fl v 6 Of i 01'1 Govt.Lot '/, '/4 S )rU T / N R // E (or) W <br /> Property Owner's Mailing Address Lot# Block# Subd.Name or CSM# <br /> 8 S'G /3,,-F t z,Address, <br /> :-i)T /Jr 4/C <br /> City State Zip Code Phone Number 0 City 0 Village El Town Nearest Road. 0/0 9 <br /> IA-)y0f ,1tvl f IrnN ISsOq) 1 ( ) I 1 51A„ss rm,r)ek-vnv,:,,,-, <br /> New Construction Use:0 Residential/Numberofbedrooms 3 Code derived design flow rate 4 t'GPD <br /> ❑Replacement p Public or commercial-Describe: <br /> Parent material Glac ,` /� Flood Plan elevation if applicable ��/� . <br /> General comments and recommendations: <br /> it <br /> Cetv'c.fe w,-y1, Tyr?', /T <br /> I67I Boring# m Boring 9 9' e <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 /> / b-Li 7,5-'1?-74 /S *Eff#1 *Eff#2 <br /> LI-30 7,5`lit ti/r-I _ /S , 7 <br /> • <br /> / E <br /> y I-SC' 7,J‘7/71/�/ S 7 / <br /> I Boring# ❑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/Ft2 <br /> In. Munsell Qu.Az.Cont.Color Gr.Sz.Sh. *Eff#1 *Eff#2 <br /> ?..-, <br /> *Effluent#1 =BOD,>30 5 220 mg/L and TSS>30 5 150 mg/L *Effluent I'2=BOD,>30<220 mg/L and TSS>30 s 150 m /L <br /> 9 <br /> CST Name(Please Print) / /1 Sig ture � / CST Number <br /> Ji. v"-es S (1,1) ✓ / 0173`/al U <br /> Address J 774 e g"-% 3 S— Draluation Conducted Telephone Number <br /> (iv-e iItY: itiT Y2/:5gi 7 S- / )(-! 7/3= Bice /I 7 <br /> SBD-8330(R04/15) <br />