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Wisconsin Department of Safety and Professional Services <br /> Division of Industry Services <br /> SOIL EVALUATION REPOT _ Page_of_ <br /> in accordance with SPS 383,Wis. Adm. Code <br /> Attach complete <br /> mplete site plan on paper not less than 8 1/2 x 11 inches in size.Plan must Re"b^ 7�4- <br /> include,but not limited to:vertical and horizontal reference point(BM),direction and Parcel I.D.p 7-Of IV-01- 38- /S-0'7-S- <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. coal - o 060 <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)). AAA I{a-I p- f" <br /> Property Owner Property Location M <br /> Ver " c r k Govt.Lot d 1/4 1/4 S 7 T 3S N R f,s— E(or)W <br /> Property Owner's Mailing Address Lot# Block# Subd.Name or CSM# <br /> S6 / C'u l b tr sbN /fid <br /> City State Zip Code Phone Number ity ❑village Town Nearest Roads 4 <br /> W-ebst{r WX' I 5-1y3g3 (-1/.5�) azo , �d�"`/ Ga F //e ff-r- Irtso 00 <br /> nNew Construction Use[Z Residential/Number of bedrooms Code derived design flow rate 300 GPD <br /> EReplacement ❑ Public or commercial-Describe: <br /> Parent material l 1 a / I/� F7 Flood Plain elevation if applicable Why ft. <br /> General comments S <br /> and recommendations: <br /> Boring# Boring <br /> Pit Ground surface elev. 96, 9 ft. Depth to limiting fact( ]O_in. <br /> Soil Application Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fl? <br /> in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 'Eff#2 <br /> O- 7S`1R3/d1 — /S hoSbk / GS 3uf .7 / d <br /> tyyz ylN — /1C✓ ,» dAe »n / G s vie •S I• Q <br /> 6 .5 <br /> 4G 70 7.S 'y/Y t — - S- /• 0 <br /> 7 Boring# ❑ Boring <br /> pit Ground surface elev. 96.7 ft. Depth to limiting factor .Sef In. <br /> Soil Application Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff <br /> in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. I •Eff#1 •Eff#2 <br /> lin s�i l <br /> 38-sol 7•S t7/7 % — J 1CS d M s bk »� 1 G s — s— A0 <br /> S 7.sy%Z%y Ca•d -5-71?s � S ms 6/c ,.,., <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 /> CST Name (Please Print) Signature CST Number <br /> ,�)a.r Is d 73y�e <br /> Address Gf Date Evaluation Conducted Telephone Number <br /> t4/J'- syCy 3 - e=/-f- 71S-:: <br /> SBD-8330(807/13) <br />