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Wis. Dept_ of Safety and Professional Services SOIL EVALUATION REPORT T / Page of <br />Division of Safety and Buildings J / ' /-7--I q <br />lil G1..VVIV6fYK Y/Illi J! -J JVJ, `JVIJ. /"1Vif 1. I..UVG <br />County <br />Depth <br />in. <br />Attach complete site plan on paper not less than 8 1t2 x 11 inches in size. Plan must <br />v ikeLf <br />onsistence <br />Parcel I.D. <br />Roots <br />include, but not limited to: vertical and. horizontal reference point (Blot), direction and <br />percent slope, scale or dimensignsr orth array. and location, and distance taneemst road.pit-pT��2- <br />ff#1 ` <br />-�N •Z Q y C � O JAJW <br />Revieti y A <br />0 Date <br />Please print all information. <br />Personal in;orrnation you provide may be used for secondary purposes (Privacy U v, s. 415,04 (1) (m)). <br />(� <br />Property Owner <br />Property Location <br />.5Y 4/6 <br />frf Q� <br />Govt_ Lot 114 114 'Sli <br />f , 3q. N R / E (or)o <br />roperty.�Owners Mailino Adddrrresp <br />Lot # <br />Block # <br />Subd. Name or CSW, <br />I <br />City State Zip Code Phone Number <br />6naN% <br />❑ City ❑ vi':la e , own <br />Nearest ARo�d <br />W� 5' o (?i5 )�� z177 <br />�►�t <br />r <br />❑ New Construction User Residential ! Number of bedrooms Code derived design flow rate 300 <br />GPD <br />PS Replacement ❑ Public or Commercial - Describe: <br />i 1 <br />/ <br />Parent material CIRC, A� p�, jC� Flood Plain ele:Vation if applicable <br />t I <br />General comments <br />l <br />and recommendations: <br />1 <br />� BoringF-1� <br />Boring # F= Pit Ground surface etev_ t. / i_ Depth to limiting favor 7 in. <br />Soil Application Rate <br />Horizon <br />Depth <br />in. <br />Dominant Color <br />I Munsell <br />Redox Description Texture Structure <br />Cru. Sz. Cont. Color Gr. Sz. Sh. <br />onsistence <br />oundary <br />Roots <br />I GPD/R <br />ff#1 ff#2 <br />ff#1 ` <br />ff#2 <br />.5Y 4/6 <br />Z <br />3-11 <br />7.2 y/0 <br />F <br />4=r <br />.7 <br />I <br />� ' <br />it <br />r <br />i 1 <br />I <br />t I <br />l <br />1 <br />I <br />, , <br />F77-1Bonin 7 Boring 9 � Q �i�/ <br />pi{ Ground surface elev. / _ Depth to fimitina factor Ivy in. <br />Horizon <br />Depth <br />in. <br />Dominant Color <br />Munsell <br />Redox Description <br />ou. Sz_ Cant. Colcr <br />Texture <br />j <br />Structure <br />Gr. Sz S t <br />consistence <br />I <br />Boundary <br />I <br />Roots <br />GPD/ft <br />ff#1 ` <br />ff#2 <br />Z <br />3-11 <br />7.2 y/0 <br />F <br />1 <br />, , <br />i <br />I <br />Effluent #1 = BOD � > 30 < 220 mg/- and TSS >30 < 150 mglL - Efriuent #2 = 801) _ < 30 mg/L and TSS < 30 mg1L <br />CST Na lease Pr r Signatur CST Number <br />Kos /6G�¢ �r• 86"1 %-/ <br />1 Address Date Evalruation Conducted Telephone Number <br />i �7Z�d �41y/%Sort G1%�57�� tea` ��3 /d'S' /•7 7�5�5'66- oza� <br />SBD -8330 (R11111) <br />