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Wisconsin Department of Safety&Professional Services ORIGINAL Page of <br /> Division of Industry Services ��-� 2 <br /> SOIL EVALUATION REPORT <br /> County <br /> In accordance with SPS 385,Wis.Adm.Code <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, Parcel 1.0. <br /> scale or dimensions,north arrow,and location and distance to nearest road. O�O/k—Z'3&-�j'0�� a5'-C 6 30bo <br /> Please print all information. R vi d bX I Da e <br /> Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). <br /> Property OwneL., Property Location ❑ <br /> LYJ <br /> Jii- O Govt.Lot r-00 '/. % S T 3e NII''R /j E(or) W <br /> Property Owner's MailingAddres SiteAb f�sor�7 and I (1900 �QK2 <br /> �l i92 <br /> City State, ip Phone Number ❑ City ❑Vill a Town Nearest Road <br /> a <br /> New Construction Use:❑Residential/Numberof bedrooms_ A Code derived designflow rate GPD <br /> Replacement A jubl'c or commercial—Describe: Flood Plan elevation if applicable�) _ft. <br /> Parent materla � FT <br /> General comments and recommendations: v I� q�37 <br /> F-11Boring# ❑Boring <br /> (wit Ground surface elev. 5lft. Depth to limiting factorff--in.!elev. ft. <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 /> b�• ! e3lL — ML Zl�i 45 7� y s 1 .7 <br /> -70 .-yQ r 1099 •7 16 <br /> I `t Boring# Boring G <br /> l-1 Pit Ground surface elev. lft. Depth to limiting factor in./elev. ft. <br /> Soil Application Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/Ftz <br /> In. Munsell Qu.Az.Cont.Color Gr.Sz.Sh. "Eff#1 I Eff#2 <br /> Z4b Mi- 65 ZA .6 <br /> 2q-5D 7,iY /,Y — ti ot- 1 F .77 116 <br /> 50- 67 P /L/ ElP SY45/ In� ,7 <br /> CST Print) i SI nature CST Number a61�5,� <br /> �S, Name(PI Pr n, 9 v <br /> /Loti TII�� <br /> Address -f Date Evaluation Cortd ducted <br /> Zy Telephone Number <br /> Effluent#1 =BOD>30 9 220 mg/L and TSS>30 5150 mg/L "Effluent#2=BOO,5 30 mg/L and TSS s 30 mg/L SBD-8330(R03122) <br />