Laserfiche WebLink
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 l lI I5-13 <br /> Attach complete site plan on paper not less than 8 1/2 x 11 inches in size.Plan must County 13rnvvte-ff <br /> include,but not limited to:vertical and horizontal reference point(BM),direction and Parcel I.D.67-cjd yo'/y'/8-505, <br /> percent slope,scale ordimensions,north arrow,and location and distance to nearest road. -0 03-6A;700 0 <br /> Please print all information. y Date <br /> XX <br /> Personal information you provide may be used for secondary purposes(Privacy Law,S.15.04(1)(m)). ),4 I// <br /> Property Owner Property Location IV ❑ <br /> El <br /> r' 1,<_HA C(ar!< Govt.Lot 3 1/4 1/4 S /$ T c/p N R/y E(or)W <br /> Property Owner's Mailing Address Lot# Block# Subd.Name or CSM# <br /> oS 5. stti St � V• l/ /� Nb <br /> City State Zip Code Phone Number -[]City ®Village Town Nearest Road ,l 97ti7 <br /> 0 ICAroc34 /4 S s77 ( ) Seo <br /> ri New Construction Usefo Residential/Number of bedrooms_ 1Code derived design flow rate_ /So GPD <br /> ®Replacement ❑ Public or commercial-Describe: <br /> Parent material G/a c r f 0"/ti<f Flood Plain elevation if applicable /✓//9 ft. <br /> General comments S S / 4 3, a <br /> and recommendations: <br /> Boring# <br /> 1 Boring <br /> ❑ �j 7. O <br /> © pit Ground surface elev. ft. Depth to limiting factor > YaZ 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 /> 0 - L-1 '�Stj/73/� /s IN'..56/� GS 'SM 7 /. G <br /> cl- - /. O <br /> vn <br /> 3 3d- `r b' 7sYrz�f/4 �F� �rns(!c �ti I Gs , O <br /> ti 9Y-Sr 7 sRs%v <br /> Boring# ® Boring <br /> ® Pit Ground surface elev. `�7. `/ ft. Depth to limiting factor 9 0 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 /> l <br /> 0 - 11 7.sri?7/t /c P . f cs 3.++ . 7 /, 6 <br /> J- y'X?. 7s y2 `'/G /r=S o1.•• s5/� ,., f �s co s- /, o <br /> S 6/c <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 gi Lure CST Number <br /> ,) a w. �3 s /�a te t. /-f d 7 3 y,4 v <br /> Address Date Evaluation Conducted Telephone Number <br /> d 7 7G o /y,,,, 3 S w �e bS e., w� S5Y15 3 9— d 3-- s— lis- 8GG- 4Y/s77 <br /> SBD-8330(1107/13) <br />