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Wisconsin Department of Safety&Professional Services Page of <br /> 0 Division of Industry Services C �/t_- •,2.2. <br /> ',,1S'= SOIL EVALUATION REPORT <br /> �a' ezn-7--W In accordance with SPS 385,Wis.Adm.Code County �uur nt,-t 1 <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. Cil-�i 1 Z-2-1Di-15 -31 -5 t 5-ttl-C 11 0-00 <br /> Please print all information. Reviewed by Date <br /> Personal information you provide may be used for secondary purposes(Privacy Law,s. 15.04(1)(m)). GC�t ��ry 10/l/2q <br /> Property Owner Property Location ❑ ZI <br /> !_ U0/At_k.- C` nA-�-( FG Govt. Lot 6 '/. 1/ S 31 T 410 N R 1 E(or) <br /> Property Owner's Mailing Address Site Address or CSM and Lot#: <br /> 15 o S4 J fie. 1Z& 1,0 51.o 1. Cc .n,+1 Rd. . 4 <br /> City, State,Zip Phone Number 0 City 0 Village 0 Town Nearest Road <br /> ve.n ,w t S�L -12 ( ) �ciLScr) C+-t .cL A <br /> ❑ New Construction Use:❑ Residential/Number of bedrooms Code derived designflow rate GPD <br /> ❑ Replacement 0 Public or commercial-Describe: Flood Plan elevation if applicable /Lf l ft. <br /> Parent material <br /> General comments and recommendations: <br /> F-Lr'oaci -c-o\(- Pi-E- Pr I U LI —Eau. t t Sg 15 <br /> f Boring# Boring A � 7�^ <br /> ❑Pit Ground surface elev. ,�I ft. Depth to limiting factor Qn./elev. ft. <br /> 60r; ' (bYlG 2c 04 Kw I rtevt s-ec ,2I/V y /t(C4.Jtba 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 /> l 0-5 1'5/(k L1J is ts6 k •-1 l . Co <br /> 2 5-Zo 1. SN)24/y -- 15 b 5, - •7 1 • Lv <br /> Zo -3co to`(r2 41/3 -- G Zrnsbk _ - • Z • 3 <br /> y 34-ta0 1.5102 9(y S OSg • 7 l - Lv <br /> ❑Boring <br /> Boring# ❑Pit Ground surface elev. ft. Depth to limiting factor in./elev. ft. <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 /> C,ST Name(Please rint)/7 Signa r� :L____/ CST Number <br /> kattu <br /> Address Date Evaluation Conducted Telephone Number <br /> U.vAtA--- CDtt.41;41 lG1iD ]202i-{ <br /> *Effluent#1 =BOD>30<_220 mg/L and TSS>30<_150 mg/L *Effluent#2=BOD,<_30 mg/L and TSS<_30 mg/L <br /> SBD-8330(R03/22) <br />