Laserfiche WebLink
Wisconsin Department of Safety and Professional Services <br /> Division of Industry Services Page of <br /> SOIL EVALUATION REPORT a` 3 -D D_ - I U 1 <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, �� lt <br /> but not limited to:vertical and horizontal reference point(BM),direction and percent slope, Parcel .D. <br /> scale or dimensions,north arrow,and location and distance to nearest road. 07-v� •�-ye-ib ''� -S'/S-`5"�f <br /> Please print all information. e law by Date <br /> Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). <br /> Property Owner 61, / <br /> Property Location 0 <br /> RO.h erq- Fl e. G Govt.Lot '/, % S <br /> L/G` N R /6 E (or) W <br /> Property Owner's Mailing Address Lot# Block# Subd.Name or CSM# <br /> sus ,4 /10vt1uiin i4ve 7 <br /> City State Zip Code Phone Number <br /> I I S`1/ 0 City 0 Village (Town Nearest Road �,9C/9 <br /> w /"/ 7 y ) I Gatk/ d k'h;/eta;( Teo-, <br /> .3 70 I <br /> ❑ NewConstruction Use:®Residential/Numberofbedrooms a Code derived design flow rate 300O GPD <br /> ® Replacement ❑Public or f commercial-Describe: <br /> Parent material Clad li o�•; Flood Plan elevation if applicable�/fi ft. <br /> General comments and recommendations: <br /> Sys. e/ v 93•s, - <br /> I / I Boring# 0 Boring21 qs• b <br /> Pit Ground surface elev. ft. Depth to limiting factor 70in. <br /> • <br /> Soil Application Rate <br /> Horizon Depth Dominant Color Redox Description ' Texture Structure Consistence Boundary Roots .GPD/Ftz <br /> Munsell Qu.Az.Cont.Color Gr.Sz.Sh. <br /> f *Eff#1 *Eff#2! I. 6 <br /> / 0- y 7.SyA /J %S 1hiS4 it:. rn C 5 3hi <br /> 21 1c67O75iR /1 — S I � � M `7 / „I <br /> Boring# ❑Boring 9S <br /> 2 Pit Ground surface elev. ft. Depth to limiting factor 7b tn. <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 /> o-y 7,s`1l1 3ti — /S /w,sb/‘ rr" i e 5' M , 7 <br /> y 7 <br /> - /D .stiiz LI/� /s r. k l 6 <br /> 3 1G- .5 y 7.5 -1/? /y S 656 yt, 7 6. S ,,t m . 7 /. 6 <br /> 41 .5-'1- '7G 75''717.shy 5 ©_I <br /> *Effluent#1 =SOD,>30 s'220 mg/L and TSS>30 s 150 mg/L *Effluent#2=BOD,>30 5 220 mg/L and TSS>30 s 150 mg/L <br /> 3T Name(Please Print) Sign ure CST Number <br /> ...)G.l i rs 3 1-77t,i e 1$ no.1 //o ,i 7.7 y,) U <br /> 'dress 77 Conducted <br /> ��6 � `"Y - � Da Evaluation C d Telephone Number <br /> a <br /> - _5 ,415? .S- 7,/- a,51 -2, - *6b- 41I-5`7 <br /> SBD-8330(R04/15) <br />