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Wisconsin Department of Safety and Professional Services ORIGINAL <br /> Page of <br /> C^' n <br /> Division of Industry Services ,� l-2A a oC� <br /> SOIL EVALUATION REPORT <br /> In accordance with SPS 385,Wis. Adm. Code County <br /> Attach complete site plan on paper not less than 8 112 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. y� v d <br /> scale or dimensions,north arrow,and location and distance to nearest road. ]�0 31-�' 015-6 60 <br /> Please print all information. a ie d b Date <br /> Personal information you provide may be used for secondary purposes Privacy Law,s.15.04 1)m). /opal' <br /> Property Owner ion <br /> Me f l�r V4 Y4 S 3y T N R l� ❑E (or) W <br /> Property Owner's Mailiin/g Address Block# Subd.Name or CSM#q / / <br /> 4,1 /7 k d Fri L k- N r :::�:#1 <br /> V. -7 P !G'�cs <br /> City State Zip Code Phone ❑Village �]7own Nearest Road <br /> New Construction Use:/o Residential/Numberofbedrooms_�Code derived design flow rate >�l' GPD <br /> Replacement ElPublic or commercial-Describe: <br /> Parent material_ 6�I--,C r rq Q -i it"t Flood Plan elevation If applicable ft. <br /> General comments and recommendations: <br /> Boring# ❑Boring 7� <br /> Pit Ground surface elev.If--7ft. Depth to limiting factor in. <br /> Soil Application Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/Fe <br /> In. Munsell Qu.Az.Cont.Color Gr.Sz.Sh. <br /> / *Eff#1 *Eff#2 <br /> 5�1� . 7 /, 6 <br /> y- `/5 7,5�/Z G I C- S 3 0 7 1. <br /> 7 s-�/Z 7 44 <br /> FT <br /> Boring Boring <br /> ❑Pit Ground surface elev. ft. Depth to limiting factor 3`0, <br /> Soil Ap Iication Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/Fe <br /> In. Munsell Qu.Az.Cont.Color Gr.Sz.Sh. *Eff##1 _*Eff#2 <br /> �G 7 r`/i?s -� , <br /> *Effluent#1 =BOD,>30 5 220 m /L and TSS>30 s 150 mg/L *Effluent#2=BOD,>30 s 220 mg/L and TSS>30 5 150 m /L <br /> CST Name(Please Prin. S' nature CST Number <br /> � l e(„ -e / - S0 73eft6 <br /> Address,(77 60 A v 75- ate Evaluation Conducted Telephone Number <br /> 57P— <br /> SBD-8330(R04/15) <br />