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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 �1 <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 D. <br /> scale or dimensions,north arrow,and location and distance to nearest road. V�'� � i(Q j p(, `s 00 <br /> Please print all information, v'ew by Dat <br /> Personal information you provide maybe used for seconds purposes Privacy Law,s.15.04(1)(m)). <br /> Property Owner Property Location ❑ ,© <br /> /W s1, Govt.Lot Y< V4 S 7 T N R �(�, E (or) W <br /> Property Owner's Mailing Address Lot# Block# Subd.Name or CSM# <br /> Igo dvx 6 q d V. �8 9Y <br /> City State Zip Code Phone Number ❑City ❑Village [.Town Nearest Road �)C S q <br /> v►►a fi✓.l" Stil O l S Q'� <br /> New Construction Use:91 Residential/Numberofbed rooms_3 Code derived design flow rate PTO GPD <br /> ❑Replacement ❑Public or commercial-Describe: l <br /> Parent material 4 I" � ��r �''r Flood Plan elevation If applicable N//Yft. <br /> General comments and recommendations: <br /> S S 4 �.3. 0 <br /> Boring# ❑Boring 17 <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 GPD/Ft? <br /> In. Munsell Qu.Az.Cont.Color Gr.Sz.Sh. *Eff#1 I *Eff#2 <br /> Boring# ❑Boring <br /> ❑Pit Ground surface elev. ft. Depth to limiting factor in. <br /> Soil A lication 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 /> Y 3) 73 /T /d --- S h,s S/e l (�� S Xco 7 1, 6 <br /> *Effluent#1 =BOD,>30 5 220 m /L and TSS>30 5150 mg/L *Effluent#2=BOD,>30-<220 m /L and TSS>30 5150 mg/L <br /> CST Name(Please PrI51J Sign at e CST Number <br /> 2 �Jti +, ,��� sip ?y.,a <br /> Address M-Y r-f- Da Evaluationn Conducted Telephone pNumber <br /> SBD-8330(R04115) <br />