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4�A,t1TRTA/I5, Wisconsin Department of Safety&Professional Services Page of <br /> Division of Industry Services <br /> SOIL EVALUATION REPORT <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, �f'7 <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. 6 7-072-Z-1//4 UZ- 012606 <br /> Please print all Information. Reviowed by 11PI �e 11T1Zy <br /> Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). <br /> Property Owner / Property Location 13 q <br /> av TV-?O Govt.Lot A Y. S Z 5 T I ' N R )(0 E(or) W <br /> Property Owner's Mailing Address Site Address or CSMM and Lot it <br /> yG?/ vdyjalAl Le 9y 5 La,kc 6 Rd <br /> City,State,Zip Phone Number ❑ City ❑Village Town Nearest Road <br /> ( ) sw►s5 a� 2Co Pd <br /> [] New Construction Use: Residential/Numberof bedrooms Code derived designflow rate_ 36�"O GPD <br /> Eff Replacement �� ❑Prbll or cgrpmerdat—Describe: Flood Plan elevation if applicable PI-1111- ft. <br /> Parent material l9l4CAI /ram /� <br /> General comments and recommendations: <br /> Boring# tj- oring <br /> M Ptt Ground surface elev.�.` ft. Depth to limiting factor 07- n./elev. ft. <br /> Soil Application Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/Ftz <br /> In. Munsell Qu.Az.Cont.Color Gr.Sz.Sh. "Eff#1 "Eff#2 <br /> - -713017 <br /> 41 <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, Munseli Qu.Az.Cont.Color Gr.Sz.Sh. *Eff#1 "Eff#2 <br /> CST Name(Pie Print) Signature CST Number <br /> 0y T/l e, 061 CIVY <br /> Address Date Evaluation Conducted Telephone Number <br /> d 8/ f;N {dlei-sYv� Z-/7 Z x1r-566.01c- <br /> "Effluent#1 =BOD>30 s 220 mg/L and TSS>30 5150 mg/L *Effluent#2=BOD,5 30 mg/L and TSS 5 30 mgIL <br /> SBD-8330(R03l22) <br />