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Divisorsn Department of Safety 8 Professional Services ORIGINAL Page <br /> ,aL <br /> � Division of Industry Services v� <br /> Sp s SOIL EVALUATION REPORT <br /> -mot <br /> in accordance with SIPS 385.Wis, Adm.Code County t2, RN <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, � <br /> scale or dimensions,north arrow,and location and distance to nearest road. ,v <br /> Please print all information. Reviewed by Da e <br /> Personal information you provide may be used for secondary purposes(Privacy Law,s. 15.04(1)(m)). 7�Zj <br /> Property Owner Property Location <br /> titBw4mD S 13 T yo N R <br /> Property Owner's Mailing Address Site Address or CSM and Lot <br /> 14 Z 00 0. RD• 140 <br /> City,State,Zip Q�! Phone Number ❑City ❑Vi -r Town Nearest Road fZ <br /> $ELL,t✓ PGAW MN <br /> b4 New Construction User Residential I Number of bedrooms Code derived designflow rate y GPD <br /> ❑ Replacement ❑Public or commercial-Describe _ _ Flood Plan elevation if applicable 1y-A <br /> Parent material 5At4i1.1 Y <br /> General comments and recommendations sW-6plQL</Vfl ty'vV I r A1 0.7 <br /> t R <br /> �Bonng �p <br /> Boring# Pit Ground surface elev;Jo•�ft. Depth to limning facto 7y n.!ele . +tt ft_ <br /> Sal Application Rate <br /> Horizon Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Roots GPDfFt2 <br /> In. Munsell Ou.Az.Cont Color Gr.Sz.Sh. Eff#1 Eff#2 <br /> I OAF 5 z r ^- is G5 /6 <br /> 15 olt <br /> 3 /li- 5 `+ N S m 1 -- 1 -W U. 7 <br /> i <br /> i <br /> � �Bonng <br /> I - �Q <br /> 1' Boring# Olt Ground surface eiev eft Depth to limiting factor ?q in.1 elev.111 t ft. <br /> 16.R{P. <br /> Sal Application Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPO/Ft <br /> In. Munseli Chu.Az.Cont.Color Gr.Sz.Sh. •Eff#1 'Eff#2 <br /> 1 Q-SI .5YR 2•S r f s 051rn 1 GS -M 6.7 1•4 <br /> CST Name(Please Print) Signat �f CST Number <br /> MARY JO HUPPERT(Hollister's Soil Testing8. ign) 224832 <br /> Address Date Evaluati8KCondueted Telephone Number <br /> 25720 Firefly Lane,Webster,WI 54893 Q 40 ZL1 2 <br /> Effluent#1 =BOD>30:s 220 mgtL and TS5>30 s 150 mg1L Effluent 92=BOO,s 30 mg?L and TSS s 30mgrL 550-8330(R03122) <br />