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Wisconsin Department of Safety and Professional Services <br /> Division of Industry Services <br /> SOIL EVALUATION REPORT Page_of_ <br /> in accordance with SPS 383,Wis. Adm. Code <br /> County L3n <br /> Attach complete site plan on paper not less than 81/2 x 11 inches in size.Plan must <br /> include,but not limited to:vertical and horizontal reference point(BM),direction and Parcel I.D.07-od C -;L- 40-/41- a 7-s- <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. /6_ y y f_ 64LAVIOC <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)). 21 IL 20X <br /> PropertyOwner Property Location <br /> Grp p s 1&&4 Govt.Lot SC 1/4 .5W 1/4 Saf7 T yp N R16, E(r® <br /> Property Owner's Mailing Address Lot# Block# $Ubd.Name or CSM#L ter o <br /> d>r%/<� Can , <br /> 300 O Cl n><en cn;1 11 Oefrn goFr�/,cfr r <br /> city State Zip Code Phone Number ity []Mllage O Town Nearest Road d 7/o89 <br /> ( tAbex (fi - W-rf-3907 (yiA4 )379-ff775 CAkl".d- I dgel" Kr /Z'! <br /> r New Construction Useo Residential/Number of bedrooms O( Code derived design flow rate 0000 GPD <br /> Replacement Public or commercial-Describe: Con 4,v . <br /> Parent material G/.x r a / D zCf Flood Plain elevation if applicable Al114 ft. <br /> General comments gH•aD (93.�i1 96,110)and recommendations: s ys, !ti v, �^p per <br /> m 9 3.70 Ci.;. 4d 60 W JDJ l''C <br /> W'e' R3.d0 (v3.o3 �0 9 .zo) <br /> , L <br /> S - MoWed,as 3Z3 c <br /> Boring# 11 <br /> Boring <br /> nX Pit Ground surface elev. 7 7. H ft. Depth to limiting factor > 8.! in. <br /> Soil Application Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDN <br /> in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Ef1#1 'Eff#2 <br /> / 0 -14 7.1-'1/73/.( — /S / 6/� ml �5 3F . 7 <br /> 02 <br /> //-/5' 7.s'7�P /H le r., l GS vF X -6 <br /> f 6 s <br /> 4 o- 5d 75-`//7 <br /> ® Boring# ® Boring <br /> 0 Pit Ground surface elev. 97. 6 ft. Depth to limiting factor > 80 in. <br /> Soil Application Rate <br /> Horizon Depth Dominant Color Redox Description Texture StructureConsistence Boundary Roots GPD/f? <br /> in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 I 'Eff#2 <br /> / <br /> 0, q <br /> �/ — /s -f6 /c / c s 3/f1 -7 1, 6 <br /> 1-/-J O 7"/? 41/y — /S m ,A/c � 65 3 m . 7 / <br /> 3 do•-y7 7s-27?y/6 — J o S 6• ,, l 6 5 - . 7 4 .6 <br /> y v7- eo 7,s^�R%y — s o s e,' — — 7 1, 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) Signature ^�{ CST Number <br /> .J 6✓✓i -e -f G/G yr/-C/S f 4) al '734/ b <br /> Address U Date Evaluation Conducted Telephone Number <br /> 77 6,0 N,,, 31- w e(,s/Y Gds 3"11gs,7 S'- 8- /.S -1/5-' 8'6,6- `11-f7 <br /> SBD-8330(R07/13) <br />