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Wisconsin Department of Safety and Professional Services ORIGINAL <br /> Division of Industry Services <br /> SOIL EVALUATION REPORT Page_of_ <br /> in accordance with SPS 383,Wis. Adm. Code <br /> Attach complete site plan on paper not less than 8 1/2 x 11 inches in size.Plan must County 14 14� <br /> include,but not limited to:vertical and horizontal reference point(BM),direction and Parcel I.D.07 Dad e1 Nv /b l9 .S-r �'3 6 <br /> ,S0 <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. p gdo oO <br /> Please print all information. R iewed by Date <br /> Personal Information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). -1 -lam-l S <br /> PropertyOwner Property Location <br /> �"p)r A"arrr L/,--cf Govt.Lot 1/4 1/4 S19 T 410 N R /(o L 1 17 F1 <br /> Property Owner's Mailing Address Lot^# Block# Subd.Name or CSM# .j r.nSr;l 44j<tl;u-e, <br /> A?909 No ,Pwbro/C-e doe X V,de C , bivr4t( 4Icct L3K� <br /> City State Zip Code Phone Number ty []Mllage MTowh Nearest Road <br /> 5 0" Hi", 9�'a 16130 ) H-70) 9--d 7?f I pc,k te- cQ /tea✓le- ,$-i <br /> New Construction Useo Residential/Number of bedrooms 3 Code derived design flow rate e/S O GPD <br /> Replacement El Public or commercial-Describe: <br /> Parent material 1 1v r rF Flood Plain elevation if applicable <br /> General comments -�— <br /> and recommendations: ys <br /> ❑ Boring# Boring <br /> Pit Ground surface elev. `j(r, 7 ft. Depth to limiting factor 7 '76 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 /> 7sme /S /m.abIt m 1 G 3/ 7 /. d <br /> /s JMsb . 7 /. 6 <br /> s CRS G , 1 s _ 7 1.6 <br /> �l <br /> 5-1- 74 7--r7,? — S mS(� V)j 1 — — . -7 /. 6 <br /> Boring# © Boring <br /> ® Pit Ground surface elev.-9S- 9 ft. Depth to limiting factor 7 /o 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 /> © - a 7,5 %/23/ _ I S 44146lle- cs 3r 7 /. 6 <br /> a - 70 7.S°ii2`/Y /S o)rr56le t GS Ivf •7 /. 6 <br /> 3 3e-sw 7.S-yf?``/� — s os� N, ( _ 7 /, 6 <br /> 65 7.s7/?fly — s o S.y <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) Signal re C CST Number <br /> a WA >°s s /�G h, a/f J 3r4/J a <br /> Address Date Evaluation Conducted Telephone Number <br /> � 7 76 D M-' 3S ���yr, t✓S �'/8S3 7 /-//s 7 <br /> SBD-8330(R07/13) <br />