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�`�"Ri�".,l� ORIGINAL <br /> Wisconsin Department of Safety&Profess onal S i es I h� Page of <br /> :0 , Division of Industry Services G�T= 5-1 ` <br /> s `' PS ' SOIL EVALUATION REPORT <br /> try„_„,,..:*`fin 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, ui,r-n P++' <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. r,r)•D'3; ?-14/-1 b 2 ,-2.-b 9-oc-11f7 t> <br /> Please print all information. Revi wed by Date7 )� <br /> Personal information you provide may be used for secondary purposes(Privacy Law,S. 15.04(1)(m)). 7/J / S <br /> Property Owner Property Location 0 ❑ <br /> �`e c.--5P f ,(\ n Govt.Lot '/< '/< S Z( T y/ N R /0 E(or)& <br /> Property Owner's Mai*lin,o Address Site Address or CSM and Lot#: <br /> 3 c.,Z57 ri1‘necv& Vckm \Zd 3o2S7 M!ntcvc. hevv. Rd <br /> City,State,Zip Phone Number ❑ City ❑Village Et Town Nearest Road <br /> T7ewth it y k sq 1)Q ('h0-77)2-42-21S1 Li i \n/M iyxer c,b tv 1Z.d <br /> S New Construction Use:Residential/Number of bedrooms 2- Code derived designflow rate 300 GPD <br /> ❑ Replacement 0 Public or�c�ommerci I-Describe: Flood Plan elevation if applicable �-. ft. <br /> Parent material t)I a t.i r+, �T�*+ c,in Jtf OL)k L h <br /> General comments and recommendations: / G,l5 e It 94/ <br /> ❑Boring ((J Y i, C <br /> Boring# Pit Ground surface elev'"/49,6 ft. Depth to limiting factor:3. in./elev.8 q•cift. <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 D5 1,sye 'i- ► ., % r 1 v '. pi C$ /FV : /, i, <br /> 2 S-24f �,S�IZ `VV4 I 1► K 0I G5 �/'i , 1 / ) <br /> 3 2q-�3 1.C1 /I0 :.J O St4 IA I ./�— i� .7 // ,,/ <br /> • <br /> ❑ g Q�] <br /> Boring# '_P trin Ground surface elev. -1 % ft. Depth to limiting factor-7 b in./elev.91L7ft. <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 0-5 715 1/ 15 1 rnsbk NA I CC / i & <br /> 2 S 3Z , 4- 15 19' I LS 2-/4 7 /. ea <br /> 3 127(42 /sritNc.0 43 Ca Inn Z - , 7 7, < <br /> CST Name(Please Print) Signature CST Number <br /> Richard Hopkins 1 — 2.2.5851 <br /> Address WI Date vat//$/2- 5 <br /> C u Telephone�y Numberp <br /> 2'11too l4wV 35 Webs+er 1 is - ewe -y 15-1 <br /> *Effluent#1 =BOD>30 5 220 mg/L and TSS>30 5150 mg/L *Effluent#2=BOD,5 30 mg/L and TSS s 30 mg/L <br /> SBD-8330(R03/22) <br />