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ORIGINAL <br /> Wisconsin Department of Safety and Professional Services Page of <br /> Division of Industry Services C,57.24— (oL <br /> SOIL EVALUATION REPORT <br /> In accordance with SPS 385,Wis. Adm. Code County 13 <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. _��_17-13 -S- yr"(i"-6/5 OCC <br /> scale or dimensions,north arrow,and location and distance to nearest road. 0-o3 �t <br /> Please print all information. Reviewed Date <br /> Personal information you provide may be used for secondary purposes(Privacyby Law,s.15.04(1)m)). Ly <br /> Property Owner Property Location ff El <br /> IY7,A-k qt- !�/,d Govt.Lot Y< Y< S 13 T `62 N R /7 E (or) W <br /> Property Owner's Mailing Address Lot# 6-- jBlock# Subd.Name or CSM# <br /> City State Zip Code Phone Number ❑City ❑Village ©Town _ Nearest <br /> Road A8 y-,f <br /> �Nl,'j('J ) - Ul'11G%l�1 0/tAc6e �r �a✓i� <br /> 77% <br /> New Construction Use: Residential[Numberofbedrooms J.Code.deriveddesignflowrate 3�4' GPD -Tay- l0 25q l <br /> Replacement ❑Public or commercial-Describe: <br /> Parent material �5)t,c 1 Dr% t 4- Flood Plan elevation If applicable N�Aft. <br /> General comments and recommendations: �` 0 <br /> / g ❑Boring 7 / <br /> Borin # ®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/Fe <br /> In. Munsell Qu.Az.Cont.Color Gr.Sz.Sh. *Eff#1. *Eff#2. <br /> If �vl' L4 �.5tii�"Iy d S,,1r7s/ 1S I — - . 7 <br /> ElBoring 9 7 <br /> Boring# ®pit Ground surface elev. ft. Depth to limiting factor`S 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. *Eff#1 _4Eff#2 <br /> C ``I -7 517 V,--- wi .� /� ,, ) C S '3 m -7 116 <br /> vl y- )S" -)-5`7/7 4/& — l FS rw S-6/,- ,,, l 6 S 3 t ' S` / C/ <br /> �S Ll S'�17 y�`� 1 5 n�s6J� 1 ( S 3i- <br /> y -Sys s�i�7 �/� - 1 F1 �m5� )e M I G 5 1 y r S U <br /> S - 6-0 SY17YY c 4JS717r/k e=s dMsLA /M <br /> *Effluent#1 =BOD,>30:5 220 m /L and TSS>30 5 150 mg/L *Effluent#2=BOD,>30 5 220 m /L and TSS>30 5 150 m /L <br /> CST Name(Please Prin�j Sign at re .a CST Number <br /> Address A 77N '"Y Date valuation Conduc ed Telephone Number <br /> SBD-8330(R04/15) <br />