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Wisconsin Department of Safety and Professional Services <br /> Division of Industry Services <br /> SOIL EVALUATION REPORT '�3 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 R r n ew <br /> include,but not limited to:vertical and horizontal reference point(BM),direction and Parcel I.D.0 7-o 1,A-.I,- NG -Ir d b� <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. /S-i00-491'1000 <br /> Please print all information. RevIQwed bv Date <br /> Personal Information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). ja, ,, 'J <br /> Property Owner Property Location El <br /> se,se,k #7 A 1< i Govt.Lot 1/4 1/4 S 016 T 410 N R E(or)W <br /> Property Owner's Mailing Address !Lot <br /> Block# Subd.Name or CSM# <br /> J 7819 G/ea r-S/� e,4- <br /> City State Zip Code Phone Number ty n Town Nearest Road of�8y 9 <br /> A1�46.St�d✓ W'� s�,,P91.3 (>/S) 9U0--,1y/ 00,614.0n GlCar, 5/t Rel <br /> ® New Construction Useo Residential/Number of bedrooms�t _ Code derived design flow rate 300 GPD <br /> nReplacement rl Public o�r7 commercial-Describe: <br /> Parent material /a G/ec 1 /r i T`r Flood Plain elevation if applicable /t/1f7 ft. <br /> General comments <br /> and recommendations: Sy f e- v' <br /> Boring# <br /> Boring <br /> Q Pit Ground surface elev. '?7.O ft. Depth to limiting factor > `l I 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. 'Eff#1 I 'Eff#2 <br /> 1 <br /> 0- (4 7.S WE-6 1,05,6/e . -7 /.6 <br /> -1 7.5`7/2'/h — /S )A,j,6/c , i G S 3Cw -7 /.6 <br /> 3 . yo Sy1? <br /> N yo-9 l <br /> 75-',Y/2 <br /> 5-1 <br /> Boring# ® Boring <br /> ® Pit Ground surface elev. qs•S ft. Depth to limiting factor -2 7y in. <br /> Soil Application Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft <br /> in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 I "Eff#2 <br /> t b- S'NR',Z /S 6 /t / 5 3 M . '7 /. 6 <br /> 1 <br /> 11- 14 7..r lv? y — i s s /� ,.. ) GS 3�0 -7 /. 6 <br /> /b- sa s 46 — s asp rrl 6 s <br /> 'Effluent#1 =BOD >30<220 mglL and TSS>30<150 mg/L 'Effluent#2=BOD,:5 30 mg/L and TSS<30 mg/L <br /> CST Name(Please Print) Signature CST Number <br /> .J^ e s S �&n , -e/s .S '73 vw <br /> Address V Date Evaluation Conducted Telephone Number <br /> al 7-7(o o amu,r X!_ - Lv e 10 j e- W.7 fie/f 53 /d -d- iS�' yrs- 5?,06-- y1.s-7 <br /> SBD-8330(R07/13) <br />