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Wisconsin Department of Safety&Professional Services_ J Page of__z <br /> Division of Indust Services <br /> SOIL EVALUATION REPORT <br /> In accordance with SPS 385,Wis.Adm.Code County <br /> �"6 NETT <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 I.D. --7 <br /> scale or dimensions, north arrow,and location and distance to nearest road. - <br /> Please print all information. Reviewed by Date <br /> Personal information you provide may be used for secondary purposes(Privacy Law,s. 15.04(1)(m)). 5 f ZS <br /> Property Owner Property Location ❑ <br /> 1 UJ e +?__ Govt.Lot '/< /< S ZS T yd N R 1 S E(or) <br /> Property Owner's Mailing Address Site Address or CSM and Lot#: <br /> 91­4�5 T +^ - L.h 2-7-12 1 I.wvA 5v✓1 PA <br /> City,State,Zip Phone Number ❑ City ❑Village RTown Nearest Road <br /> v e r Grcle Oet 5 Mt, S50-7*7 (C,l2 )9 4 0- Z-695- mctt�Qn. rtkok, San C� <br /> ❑ New Construction Use:aResidential/Numberofbedrooms 3 Code derived designflow rate C)GPD <br /> Replacement ❑ Public or commercial—Describe: Flood Plan elevation if applicable ft. <br /> Parent material Ou+vja51A <br /> General comments and recommendations: n <br /> Ssn` h d yr ri' DT via4urAl to .560. <br /> © Boring# ❑Boring ,, <br /> [ Pit Ground surface elev.�3ft. Depth to limiting factor '50 in./elev.�10.0. <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 /> 6 0- '7.5_W1_3-Z L I-' Sbl<- t-+V4PZ P S I . -I 1,& <br /> 2 6 ' 5 ?•SY2N-lo t-5 Ijp5b1= MJFIB C5 • -7 1. (o <br /> P- q-9 L-5 I �-' Sbr, ti'lV CS 1 1 (p <br /> F�] <br /> Boring# [—]Boring ,• <br /> wit Ground surface elev.9to ft. Depth to limiting factor 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 /> -S /z3-z L 5 1F58k t-A IJF- 1 tA .7 <br /> Z �I-Zla .5YR 4-40 L r F5SK MJFEZ L' J . 7 1, b <br /> 90 15-Y LI-4 F5 We— M V FiZ 1. Lo <br /> CST Name(Please Print) Signature CST Number ickolgS P\j91LS l m00002Z- <br /> Sp <br /> Address Date Evaluation Conducted Telephone Number 21-RoO oJe-Wer" WI -,I V-Z 5-Z -7 ►5-25 -Ll I _-7 <br /> *Effluent#1 =BOD>30<_220 mg/L and TSS>30<_150 mg/L *Effluent#2=BOD, <_30 mg/L and TSS<_30 mg/L <br /> SBD-8330(R03/22) <br />