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Wisconsin Department of Safety and Professional Services <br /> Division of Industry Services <br /> SOIL EVALUATION REPORT Page_of_ <br /> in accordance with SPS 383,Wis. Adm. Code C <br /> Attach complete site plan on paper not less than 8 1/2 x 11 inches in size.Plan must County h e7`f <br /> include,but not limited to:vertical and horizontal reference point(BM),direction and Parcel I.D.0'7-5 J O-,Z-40-/6-33-5 0 <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. , Oo d- 0/9000 <br /> Please print all information. Reviewed bey �Date �� L <br /> Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). G%'l/✓ -CvI^I�' rV <br /> Property Owner Property Location <br /> El F1 <br /> I�QaSC Govt.Lot 1/4 1/4 S ;13 T o/O N R /(6 E(or)W <br /> Property Owner's Mailing Address Lot# Block# Subd.Name or CSM# <br /> -tea 1 /9s 4/u h e /4„e 3 1 1 v 3 r? ?/ <br /> City State Zip Code Phone Number City ®Village X Town Nearest Road A741d q <br /> Srfau ( YhN lSI0al (�S/).?/S 9d7 Ce-/c/s., <br /> y CP 5-/o <br /> rl New Construction Useo Residential/Number of bedrooms 3 Code derived design Flow rate YSO GPD <br /> ZReplacement ® Public or com-m/ercial-Describe: <br /> Parent material G/it G/^ / �f rT Flood Plain elevation if applicable <br /> General comments / <br /> and recommendations: S�S eke 1/,. l 3. 00 fo 257-00) <br /> dapped as A-3g8 - "r Colin- Aenati50, %e,>< <br /> ❑ <br /> / Boring# ® Boring <br /> 17 Pit Ground surface elev. SG •O ft. Depth to limiting factor >ZJ in. <br /> Soil Application Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/f` <br /> in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 I 'Eff#2 <br /> s- -11-e z <br /> 7.s�//� `�/y — s oi.. s 6/e y, t G s of M . 7 /. <br /> y Sb-7,t 7.sYA <br /> Boring# ® Boring <br /> 0 Pit Ground surface elev. 1 61. ft. Depth to limiting factor 7 7f in. <br /> Soil Application Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF <br /> in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 'Eff#2 <br /> y 34 -7 fy,R%y >s J6/� <br /> 3 3`- 6o 7sit' <br /> y/v <br /> Effluent#1 =BODS>30<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) Sign ure ll CST Number <br /> Je-. �,l .ss .S DAni-le/J S CJ T '/�AO <br /> Address V Date Evaluation Conducted Telephone Number <br /> 77G0 ,'!• 3S w ebr�Y w1 3 5'g 9.� 3_ i-7- /s ��s', 9.660 - Ni 7 <br /> 0D-6330(R07/13) <br />