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Wisconsin Department of Safety and Professional Services ORIGINAL <br /> Division,t Industry Services <br /> SOIL EVALUATION REPORT �)p Page_of_ <br /> In accordance with SPS 383,Wis- Adm. Code CS 1 1(a D o <br /> County /3,ent 7� <br /> Attach complete site plan on paper not less than 81/2 x 11 Inches M size.Plan mus[ <br /> include,but not <br /> scale rdb:verticalantl rma arrow,reference <br /> catiopoint(dist distance <br /> to <br /> are Parcel LD.O]-OAQ.1-VISd S'7 S-S <br /> percent slope,scale,rtlimensions,,ortharrow,aM location and tlistance to nearest road. /S•S�L-O}So0 <br /> Please print all information. Reviewed by Date <br /> Perawa.tr unarm you oromdo may be owd for surer",ou......Law y Law,s.15.04(1)up) N��� y�4VI 9 <br /> Property Owner L Property Location <br /> >I$/i((rw rw SO✓Af/Gr - � Govt Lot Jw 1/45- 1/4 S� TyO:N R/H EE(or)W <br /> Pmpany0wner's Mailing Address ,: Lot# Block#. Srrbtl.Nameor CSM# <br /> O ljn.t F/S .. . . !D N ���/Q 7D y/.06. KwJOLL , <br /> City - Stale Zip C,tle Phone Number - ity ®Village Town „ Nearest Road d66S <br /> 901/H <br /> Waver/ /A Soc77 ( , ) e.K.� //'n'oP:. <br /> New Construction Usefp Residential/Number of bedrooms 3 Code derived design Low rate S'SO GPD <br /> ®Replacement ❑ PeMbe.rcarmcdcam Describe: <br /> Parent material c/ n <br /> a t r / r✓•rr+ Flood Plain elevation if applicable ft. <br /> General comments Syf. <br /> and recommendations: / <br /> E Boring# [I Boring <br /> ® Pit Gramotiomfoceelev. '76-1( ft. Depth to limiting factor 184 in. SedApplication Rate <br /> Horizon I Depth p,minanl Color Retlox Description Texture Structure Consistence Boundary Roots GPD/fF <br /> in. Munsell Go,Sz. Cant Color Gr Sz.Sb. 'Effp1 'Eff#2 <br /> / e- H /S /n 56/c r., l c3 3in ,7 /. 6 <br /> 1I-Sa 7 S-7/Z — Jr ms G / G S l .7 144 <br /> 7•S`rr/Z'r/y S a3 6 ...-. t — - .7 /•b <br /> Boring# ❑ Boring <br /> ® <br /> Pit Ground surface elev. 4S� p. Depth to limiting factor 7 7A/ in. Soil Apoicabort Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDN <br /> in. Munsell Ou.Sz. Cont.Color Gr.Sz.Sh. 'ER#1 'Eff#2 <br /> ! a� V 7SY/Z 3/j, /S /mars/! .cn / cs 3m . 7 /•6 <br /> d y-db 7.S'Me Y/v — /.5 J. S6/c , f. : ryS1 ace . 7 /. 6 <br /> 3 b-.r1 76-Y? 4/y s ex 6 /..., / - - S .-7 1,4 <br /> y a-7Y 7SY/T�H S e,SG ,-: — -7 <br /> .rr . <br /> 'EHluenl#1 =B00 >30<220 mglL and TSS>30<150 mg/L 'Effluent#2=BOD, 30 mi and TSS<30 ani <br /> CST Name(Please Print) Signature CST Number <br /> /jr at <br /> 7 <br /> Address Dale Evaluation Conducted Telephone Number <br /> d 760 f1—? 3s o✓s b s7Lre- wr SVBSJ a 7 <br /> SLID 8330(1407/13) <br />