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Wisconsin Department of Safety and Professional Services ORIGINAL <br /> Division of Industry Services <br /> SOIL EVALUATION REPORT Page_of_ <br /> in accordance with SPS 383,Ws. Adam Cade <br /> County �c,.r ,t t)41— <br /> Attach complete site plan vertical <br /> paper not h horizontal <br /> than 81/2 x e Inches in size.Plan must <br /> percentude,but eslimited di vesionan north zona,reference point(BMtpince to nand pang /9 <br /> percent slope.scale or dimensions,north arrow,and location antltliSlance to nearest road. p}=C�01 - U1�'Y�UJ <br /> Please Print all information. Reviewed by Data <br /> Prra,mi mfnrmatmn may to ri is, romli mrpo%ea lPn,a=v Law,a.1504(1)(me neon. fW/d/A/ /O-////J <br /> Property Owner Property Location <br /> Cd n 125 JPMn NQY Go .Enol E114N✓114 B dST ', ON R'/6 E❑(or)W <br /> Property Onner's Mailing Address r Lot or Block# I Subtl.Names CSM#, .• _ <br /> 7dv 7- /D )3D . <br /> Gry • • State Zip Code Phone Number LiCity ❑VAtage LAJTown - Nearest RoaL d 7q Q3 <br /> /t'I /J In,,, .rS'6(3 ( G/d )67o 90S ,�acK.fiOn � � '5a' dC/c -C2a�. " <br /> ❑ New Construction Unco Residenthl/Numberofbedrooms 1 Code derived design flow rate 704 GPD <br /> 10 Replacement / Public or commeraal-Describe: <br /> Parent material 4./R CJ w./ /�:f+ Flood Plain elevation if applicable A✓//9 fl. <br /> General commenls <br /> and recommendations: SyJ. .</<✓ <br /> Bo tt Boring <br /> Boiling <br /> © pit Ground surface elev. _ft. Depth to limiting factor > 71? in. <br /> Solt AApoication Rate <br /> Horizon4D,� minant Color Redox Description Texture Structure Consistence Boundary Roots Gli <br /> Munsell Ou.Sz. Com.Color Gr.Sz.Sh. 'EfM1 'ER#2 <br /> pYR J/,t — /S /mdSk / G S .In . 7 /, 6 <br /> 5`1 Ri/y /S J••.:b /e .+• I a r d,-1 . 7 /.6 <br /> '3 Sy,? %y ,r oJG .•. I S /F . 7 /. 6 <br /> Boring# © Boring <br /> ❑ Pit Ground surfacaelev. 9.T ft. Depth to limiting factor in. Sol Application Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF <br /> in. Munsell Cm.Sic. Cont.Color Gr.Sz.Sh. 'Eff#t 'EH#2 <br /> / <br /> 10- 4 7-"rR J//. <br /> "Effluent#1 =COD,>30 220 pi and TSS>30<150 mi 'Effluent#2=BOD.<30 mgt and!TSS f 30 mA <br /> CST Name(Please Print) Si azure CST Number <br /> Address Date Evaluation Conducted Telephone Number <br /> d 776a H 3s t v<ds>� wS 3'ffi93 /� s y <br /> 7/,f_ <br /> ispati_ ys7 <br /> SBI 9330(R(17/13) <br />