Laserfiche WebLink
Wisconsin Department of Safety and Professional Services o I G I NAL Page of <br /> Division of Industry Services _f 4 <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, `-' rn Z <br /> but not limited to:vertical and horizontal reference point(BM),direction and percent slope, Parcel I.D. IS_ _S-_���t/jDate <br /> scale or dimensions,north arrow,and location and distance to nearest road. O 7—D Id'a y0' c! <br /> Please print all information. Reviewed by <br /> Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)m)).Property Owner Property Location <br /> tle l3uCr < Govt.Lot '/< Y< S /JL T C/O N R i.5 Pro artyOwner s Mailing Address Lot# Block# Subd.Name or CSM# <br /> ,rY 3.O,-w 111 home- /Nt/ V, Jg 3City State Zip CCojde Phone Number ❑City ❑Village 01 Town' Nearest Road r/Ll vfr /»/V SJ J30 ) .J� GI"50�� %'; %�,v<l C,r. <br /> New Construction Use:®Residential/Numberof bedrooms _Cade derived_design flow rate �C�U GPD <br /> Replacement J ❑Public or commercial-Describe: <br /> Parent material io /<.[i 1, f /�r i�9' Flood Plan elevation If applicable ft. <br /> General comments and recommendations: s�f C'I E t/• �j y, Zf <br /> Boring# ❑Boring > <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. <br /> *Eff#1. *Eff#2. <br /> `1 7 s``>Iz 3/j G S 3 ly/= A <br /> ❑ <br /> El Boring Boring# �S `1 7 G 0 <br /> ®Pit Ground surface elev. ft. Depth to limiting factor in. <br /> "Sc�,IAn Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Bound <br /> In. Munsell Qu.Az.Cont.Color Gr.Sz.Sh. ff#2 <br /> J 0 -L 7,S`'ice S' n, 'S k ,.� 1 G-:S . 6 <br /> C� <br /> *Effluent#1 =BOD,>30_<220 mg/L and TSS>30 s 150 m /L *Effluent#2=BOD,>30 s 220 mg/L and TSS>30-s 150 mg/L <br /> CST Name(Please Print) Sig ture CST Number <br /> i� 'S S ��.1.1,,e�r ) 7.3 ,E <br /> Address H"`7 5— D e Evaluation Conducted Telephone Number <br /> 1,✓��s r,- w��'z/1�/3 (� - l l- 7iS— (�6-- e//S_ 7 <br /> SBD-8330(R04/15) <br />