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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, D <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. 40Z WOO <br /> Please print all information. Ree by Date <br /> Personal information you provide may be used for secondary u oses Petra Law,s.15.04 1 m . 9')3 <br /> Property Owner Property Location ❑ A, <br /> t Govt.Lot N /. %. S Z T3 N R E (or) <br /> Pperty Ow er's Mailing Address Lot# Block# Subd. Name or CSM# <br /> ity� � WState Zip Code Phone Number El City E-1Village R)Town r Nearest Road <br /> 61f <br /> ❑ New construction Use:❑ Residential/Number of bedrooms Z- Code derived design flow rate- CV GPD <br /> 'K Replacement ❑Public or comm�f cial-Describe: <br /> Parent material K' `a C iQ_!_j r )r Flood Plan elevation if applicable ft. <br /> General comments and recommendations: <br /> �.r; ,•o.t._ o � Sm ;L s C <br /> 1 Boring# ❑Boringqq�� <br /> I V(Pit Ground surface elev.&-74. Depth to limiting facto%�rn. <br /> _ Soil Application Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/Ft2 <br /> In. Munsell Qu.Az.Cont.Color Gr.Sz.Sh. *Eff#1 *Eff#2 <br /> I7-S L` M/ , <br /> 2 'Z r J L? /"/nn7 �� i:C <br /> r 7 /Vi <br /> 4 =72 759 A c2 D S y S Or N►L <br /> F-1Boring# ❑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/Ft2 <br /> In. Munsell Qu.Az.Cont.Color Gr.Sz.Sh. <br /> *EfF#1 *Eff#2 <br /> *Effluent#1 =BOD,>30 s 220 m L and TSS>30:5 150 m /L *Effluent#2=BOD,>30 5 220 m /L and TSS>30 5 150 m /L <br /> CST Name(Pleas Print) SjgnatuW CSL r <br /> I ''E <br /> Address Date Eva ion Co ucted Tele hone Number <br /> _ a � - 7 S< < <br /> SBU-8330(R04115) <br />