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Wisconsin Department of Safety and Professional Services <br /> Division of Industry Services <br /> SOIL EVALUATION REP T Page_of_ <br /> in accordance with SPS 383,Wis. Adm. Code J <br /> �yr„1 <br /> Attach complete site plan on paper not less than 81/2 x 11 inches in size.Plan must County <br /> include,but not limited to:vertical and horizontal reference point(BM),direction and Parcel I.D.07-t'+A'-.-'4 4'-l5=-lr!-S_ <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. 0S - 0c ' - 041 f O00 <br /> Please print all information. Rev w by Date <br /> Personal information you provide maybe used for secondary purposes(Privacy Law,s.15.04(1)(m)). g-//-/ <br /> Property Owner Property Location <br /> ID El <br /> 1C r m Deb-so;, Govt.Lot 3 4 t( 114 114 S �k T YC N R i.5— E(or)W <br /> Property Owner's Mailing Address Lot# Block# Subd. Name or CSM# <br /> MO ,—k,n I to k1ceef 4 ki a U iC� <br /> City s} State Zip 1od4i�Phone Number ity ©tillage Town Nearest Road d Y3/9 <br /> arrne a., 46-& N SSh47 1 ( ) .id[ (c5c., OCyrnav 41e i?dW, <br /> 0 New Construction Uselo Residential/Number of bedrooms 3 Code derived design Flow rate 0 GPD <br /> IM Replacement Public or commercial-Describe: <br /> Parent material er:f®LC , I D,- !r{' Flood Plain elevation if applicable <br /> General comments <br /> and recommendations: <br /> Grors ce4VIC • oyt life <br /> Boring# Boring I &�� <br /> Pit Ground surface elev. y ft. Depth to limiting factor ) ?!q_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 /> l o-q 7syZs/.- — /.S lrnab/f sr,r cs :3vr 1-7 /. el. <br /> d 4- rill 7.s yi?'*/ti '— i �5/ s 6<< 1 G t t F . 7 <br /> A 6 <br /> ��� '7S�'/�� '�' J CAS. � F'� ( � � v / �• O <br /> Boring# n Boring c <br /> R pit Ground surface elev. 9 y= ft. Depth to limiting factor 7 �7o( 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 /> C.- 6 7-'r-w-e I /S /1"SA/__ r-r I c.s 3 et 7 1,6 <br /> 3 3d-SV 75 `712`//ti S �s ( GS �M 7 /� <br /> '7.s9R%`+ s �s 7 /.6 <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) Si nature <br /> /� CST Number <br /> va <br /> s +e's S 004 rr r (t Je---e p1 73,'1,A o <br /> Address V Date Evaluation Conducted Telephone Number <br /> 7-760 SziS3 fI- `1- /?' <br /> SBD-8330(R07/13) <br />