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Wisconsin Department of Safety and 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, <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. Q'1"Oa,6)-go-16 <br /> Please print all information. Rev' w by Date <br /> Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04 1 m)). ,!:XI.A && I 6/a 3 <br /> Property/Owner Property Location ❑ el <br /> v)�►'�S4 �2o jC k Govt.Lot '/< '/< S —/ T 4/0 N R /r6 E (or) W <br /> Property Owners Mailing Address Lot# Block# Subd.Na e or Ces-SM# <br /> city State Zip Code Phone Number ❑City ❑Village g Town Nearest Road,)9�3 <br /> tiN wr 0416141�! Ytl/Owf�jv�✓ <br /> ❑ New Construction User Residential/Numberof bedrooms_ Code derived_design flowrate300 GPD <br /> ®Replacement Pu c or commercial-Describe: <br /> Parent material - . (c,I:��` Flood Plan elevation if applicable ft. <br /> General comments and recommendations <br /> Boring 8 p <br /> Boring# 9S. 7 <br /> Ill��j III Pit Ground surface elev. ft. Depth to limiting factor in. <br /> Soil Application Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure ; Consistence Boundary Roots ..GPD/Ft? <br /> In. Munsell Qu.Az.Cont.Color Gr.Sz.S.h. *Eff#1 *Eff#2 <br /> y-,1 y �s7i7 `9/ / s <br /> y- S 7,5- '/? y/ S /6 <br /> F-1 <br /> Boring# ElBoring <br /> ❑Pit Ground surface elev. ft. Depth to limiting factor in. <br /> Soil Application Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIFe <br /> In. Munsell Qu.Az.Cont.Color Gr.Sz.Sh. <br /> *Eff#1 -.*Efr#2 <br /> `Effluent#1 =BOD,>30<_220 m /L and TSS>30 5 150 mg/L 'Effluent#2=BOD,>30 5 220 mg/L and TSS>30 5 150 mg/L <br /> CS e(Please Print) Sig atura CST Number <br /> 01 aM>%s ah 1 S / 73V <br /> Address o[ 77 6 Q w 'Y ate Evaluation Conducted Telephone Number <br /> �[� r L I o <br /> SBD-8330(R04/15) <br />