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Wisconsin Department of Safety and Professional Services <br /> Dlvlsien of Industry SeNl6es <br /> SOIL EVALUATION REPORT Page—of <br /> in accordance with BPS 383,Wis. Adm. Code k <br /> County k V n <br /> Attach complete site plan ye paper not less than B fer x 11 Inches in size.Plan must <br /> Include, lopes oleo bmensioland hodmmal reference point(distance <br /> parW LD.0%_orA_)-qG-IS-d3=1f <br /> percenlslope.swle or dimensions,noMarrow,and location and tlistancelo nearestroatl. pt=rl^vl- Gl9O� <br /> Please print all information. Reviewed by Dale <br /> Personal nforratloavouproAde may be romfor secomdan ponoses(Privacy Law,s.1s 04111(m)1- 6QA/4. Ri4y/A/ /9-&/// <br /> Property Owner Property Location ❑ <br /> C/na.•J[S lJ,r'wnm<r Govt.Lot E1I4N'�,.1/4 Sds T 'y0'N R'/S E(or)W <br /> Property Owner's Mailing Address Let# Block# Subd.Name or CSM# ' <br /> 1/.NT <br /> P 3D <br /> City • Stale Lp Code Phone Number ity ❑)/Ilage Town - Nearest Read d 79 Q3 ' <br /> /#' /,t /nth I S".foA3 ( Id )670 905- j,oc Pph 1 S4. of 4 <br /> ❑ New Construction UseEj Residential/Number of bedrooms 1 Cade derived resign flow rale 70e GPD <br /> ®Replacement ❑ Prblicor Commercial-Describe' <br /> Parent material /sera/ /7.•'F* Plead Plain elevation ilapplicable ^'/A ft <br /> General comments <br /> and recommendations: Sr✓• '</'e✓ 5a.3 <br /> During# <br /> ❑ Boring <br /> © oil Ground surface elev., (FS.N_ff. Depth to limiting factor > 7y la Soil Zion Rale <br /> HorizonMDomimantCoIorRedoxDascnpficont Color Redox Description Texture Structure Consistence Boundary Roots GPD/fe <br /> sell Cu.Sz. Cont.Color Gr.Sz.Sh. 'EWl1 'Etfll2 <br /> 3/A — /S /ms$k / C S d-1 . 7 /. 6 <br /> i2'//Y /S U b/c l G s JkR A, S oSG � S / . 7 1. 6 <br /> `/ /2'3/rr, — -T czs 6 /., 1 — - , -r (, 6 <br /> ® Boring# R Boring <br /> ❑ Pit Greundsurfaceelev. 95 '}Yft. Depthtollmitinghmarr_> Ao in. <br /> Soil AppIcaltion Rate <br /> Horizon I Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff <br /> in. Munsell Cu.Sz. Cont Color G,Sz.Sh. 'Effll 'Pill <br /> l <br /> 0- 4 -7.5-'IR /s 1,16 /< .., 1 S I . '2 <br /> h'-.1t 7.61/1 — /Jr clmin 6/c .•y / Gf J.n . -7 <br /> 3 JL SI s-,#?%q — S OSG m I — _ • '7 /. b <br /> 1/ /•84 <br /> 'EHluenl#1 =800 �30<220mg)Land TSS,30<150mg/L •Effluent#2=BOD <30mg/LandTSS<30mg/- <br /> CST Name(Please Pmr) Si ature 1 / CST Number <br /> .1.e r.•e.r S C�ari.e/s ..f/J6wJS or73Y.JD <br /> Atldress Dale Evaluation Conducted Telephone Number <br /> J776a fF 3s tv<dsr wr 3'f89 /a s-, y 7s- siG- v/s� <br /> SeD.8330(ROz/11) <br />