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Wisconsin Department of Safety and Professional Services <br /> Division of Industry Services <br /> SOIL EVALUATION REPOT Page of <br /> -►�-$ <br /> in accordance with SPS 383,Wis. Adm. Code — <br /> Attach complete site plan on paper not less than 8 112 x 11 inches in size.Plan must County /3wr h C`jf <br /> include,but not limited to:vertical and horizontal reference point(BM),direction and Parcel I.D.07-01 '40 <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. <br /> Please print all information. Rev' ed by Date <br /> Personal information you provide maybe used for secondary purposes(Privacy Law,s.15.04(1)(m)). 7-l Q_),7 <br /> y Propert Owner Property Location d <br /> W a/1k R&I'll Govt.Lot 3 114 1/4 S T 1-/0 N R /S E(or)W <br /> Property Owners Mailing Address Lot# Block# Subd.Name or CSM# <br /> / 3 3& r 4 &,vew Q,-r ve. <br /> City State Zip Code Phone Number 117=1Cily E]Village Town Nearest Road 8as'7 <br /> VIrYN i le Y)'►N ,SS"337 ( } ���ksc vi c k Rd, <br /> New Construction UselM Residential/Number of bedrooms rst Code derived design flaw rate -700 GPD <br /> ®Replacement / [] Public or commercial-Describe: <br /> Parent material G¢/AC( e-( /JNr!!�-' Flood Plain elevation if applicable !y/''M' ft. <br /> General comments �3 <br /> and recommendations: $ S Ae y, 1,.P)5,e.r <br /> Boring# Boring <br /> ® pit Ground surface elev._ �J 7+ 1f ft. Depth to limiting factory��_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 7s 70`�/y IS Iz r, ► 3•cc r 7 16 <br /> es 1 G3 ')M ,7 /, E <br /> -7 1f2'i <br /> Boring# Boring <br /> ® Pit Ground surface elev. y�.Cr1 ft. Depth to limiting factor 7 7a' 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 *Eff#2 <br /> a-y 7.J"7R X4 — 45 /Aas4le ,rn1 Cs 3m .7 46 <br /> 7.5`y i7`'/4 /.S d m sb/c Yy ( rj �; 3.+a , 7 /, d <br /> - 75- 7" /F S .al d I'e rr,l j /= , S` /, 0 <br /> *Effluent#1 =BOD >30<220 mg/L and TSS>30<150 mglL EfFluent#2=BOD <30 mg/L and TSS<30 mg/L <br /> CST Name(Please Print Signature CST Number <br /> .J tr vn s s j��1 r/ / ,173 q'A 0 <br /> Address Date Evaluation Conducted Telephone Number <br /> ?76 ,Z,<- Gy`-ed s,4r. wr SSrss 7- ►�-1� �.s 733•-o i t 7 <br /> SBD-8330(R07/13) <br />