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Wisconsin Department of Safety and Professional Services <br /> Division of Industry Services <br /> SOIL EVALUATION REPORT Page_of_ <br /> .c <br /> in accordance with SPS 383,Wis. Adm. Code <br /> County t^ a77" <br /> Attach complete site plan on paper not less than 8 1/2 x 11 inches in size.Plan must <br /> include,but not limited to:vertical and horizontal reference point(BM),direction and Parcel I.D. �v_,s td-S !S 'leo-0�3m00 <br /> J' <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. 07-0;A- ' m rd o 00 <br /> Please print all information. R viewedAy Date <br /> Personal information you provide maybe used for secondary purposes(Privacy Law,S.15.04(1)(m)). <br /> Property Owner Property Location U El <br /> M ArC- Al Govt.Lot 1/4 1/4 S ld, T cr'0 N R r�r- E(or)W <br /> Property Owner's Mailing Address Lot# Block# Subd.Name or CSM# <br /> / 3c/ c] 13russ P/cwy A%-3 <br /> City State Zip Code Phone Number ity ®Village ElTown Nearest Road <br /> r`O5'0 h9h•N IS 'S"p fpg I ( ) I J0.c.6c 0 h kr (lla...c. Crlr' <br /> Fq New Construction Usee Residential/Number of bedrooms 3 Code derived design flow rate c/SO GPD <br /> ri Replacement ® Public or commercial-Describe: <br /> Parent material G/G c [ r !Jr i `•f Flood Plain elevation if applicable //g ft. <br /> General comments /ys. 0- (r✓ �T 0 <br /> and recommendations: 7 <br /> ❑ Boring# ® Boring <br /> Pit Ground surface elev. ft. Depth to limiting factor > 7d 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. 'Eff#1 I 'Eff#2 <br /> / 6- g 7Sy/7�/a - is /,., s 3^ .-z 6 <br /> d 8-S`3 7.5-11-e 4/q - !E'S �,..s 6/< M f G S 3 <br /> 3 .5�r- 7) 7.s y/z% — s o s u �., r — d.�r 7 �, <br /> ® Boring# ® Boring <br /> Pit Ground surface elev. 9G.fJ ft. Depth to limiting factor -7 7y 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. 'Eff#1 I 'Eff#2 <br /> 0- 1 -7.5'7R 31 - ! S l s•,s b k k+ I S 3l1 . 7 /, 6 <br /> a $- 43 7sy/r v/y — Fs ..,s61e- M 1 6: ace <br /> 3 Y3- 7y 7.5"i�? ��y — -s a <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 Pri�ny Signature CST Number <br /> l2rc/C I`/0�/fi.� S / � o1�S8S1 <br /> Address / / / Date Evaluation Conducted Telephone Number <br /> �/I/ <br /> ie6.e2lYi �"1 ��� `I y-i.5� ��S-BGG - cI/S7 <br /> 013-8330(R07/13) <br />