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Wisconsin Department of Safety and Professional Services ORIGINAL <br /> Page of <br /> Division of Industry Services <br /> S / I c S SOIL EVALUATION REPORT .�-f� <br /> I l In accordance with SPS 385,Wis. Adm. Code County 13 N r N•e-( <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, c-c e1Y5_Tp_k r-o 1-So r-0oT -o li3eo <br /> scale or dimensions,north arrow,and location and distance to nearest road. • all 4 00 <br /> Please print all information. Reviewed b Date <br /> Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). C /' . 1-a0^(Oy <br /> Property Owner Property Location ❑ R <br /> Z. C-0 r Y"�r► *AAA 0.5(A 7 I've- Govt.Lot % % S 7 T 33 N R /.S- E (or) W <br /> Property Owner's Mailing Address Lot# Block# Subd.Name or CSM# <br /> 7YA /3ert4 Sr Li(.3 <br /> City State Zip Code Phone Number 0 City 0 Village ®Town Nearest Road <br /> Aw,<N r 11Nr 1511.dd1 I ( ) I ILA Fo /(iettC 1 Mot(,N f. /?( <br /> IR] New Construction Use: Residential/Numberof bedrooms of Code derived design flow rate 300GPD <br /> 0 Replacement ❑Public or commercial-Describe: <br /> Parent material ‘ IA c%.1 0, 4 'f Flood Plan elevation if applicable /eft. <br /> General comments and recommendations: ✓ 3. S <br /> Syf. <br /> ❑Boring <br /> / Boring# EaPit Ground surface elev.SS ft. Depth to limiting factor G O 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. *Eff#1 *Eff#2 <br /> I 0-8 7.5't r2 3 4- !S hN-.S /L .« ( G 5 3 r% # 7 I. L <br /> ‘), r_ Go ?.t`tX 94 — /FS rasfa/c- i..1 I G $ .co1 . S- (. O <br /> 3 0_ 4 fl 7.s yi2 ` o. G h 4 S 7df7f- I r s ),,..,5 y/c r-g ( — -- . S- 1. o <br /> 0 Boring <br /> Boring# [E5 s_Pit Ground surface elev. ft. Depth to limiting factor S6 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. *Eff#1 *Eff#2 <br /> / a-7 7 S7/?34. — /S h., S 6/c s.-., ( C S 3.n .7 /. (o <br /> d 9- SF 1,Sy,2 41/4. — //=5 A.»sMk ,r+ / G 5 3 Co . S- /. O <br /> 3 sc- GA 7..-P-TR '-'/4. 4 4to ' M%y //=5 a—J 6/c ,.,,, ► — — .. 5— /. o <br /> *Effluent#1 =BOD,>30 5 220 mg/L and TSS>30-<150 mg/L *Effluent#2=BOD,>30<_220 mg/L and TSS>30 5 150 mg/L <br /> CST Name(Please nnt) Sig Lure 'l CST Number <br /> Jµw, t- S "wr I'S fG S /� a173ciotO <br /> Address to Evaluation Conducted Telephone Number <br /> 017740 /4f%4..y 3S' 6-d6-/8 7/s- c'G ¢-11/.5- ? <br /> w e6 S 1 t°f N''.= Sit 6 5 J SBD-8330(R04/15) <br />