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Wisconsin Department of Safety and Professional Services <br />Division of Industry Services <br />SOIL EVALUATION REPORT _ I �- Page of <br />in accordance with SPS 383, Wis. Adm. Code <br />County <br />Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must P _ <br />include, but not limited to: vertical and horizontal reference point (BM), direction and Parcelos- <br />percent slope, scale or dimensions, north arrow, and location and distance to nearest road. oo2, - OSR000 <br />Please print all information. R Zviwe by Date <br />Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). 1,0_1;0 <br />Q— _t I <br />Property Owner Property Location M <br />1771 <br />P,- a 74 4 Govt. Lot a 1/4 1/4 S T y/ N R /5- E (or) W <br />Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# <br />�, 6 a ! %✓1 <br />City State Zip Code Phone Number City ❑ Village Town Nearest Road zl v36 <br />/ St <br />v, L r r�. 1 /i/,i6-.S-L1 `l I(.5 7y) ) O`1f12S— I 5Lv <br />nNew Construction UseE] Residential / Number of bedrooms 3 Code derived design flow rate G/ GPD <br />P1 Replacement [7 Public or commercial - Describe: <br />Parent material G%Glia / ��' �� Flood Plain elevation if applicable <br />General comments <br />and recommendations: 5-1y_f 1 Q ✓ _ ,3 <br />rBoring # Boring <br />Q pit Ground surface elev. gs' 9 ft. Depth to limiting factor 7 in. <br />Soi Annlicatio Rate <br />Horizon <br />Depth <br />in. <br />Dominant Color <br />Munsell <br />Redox Description <br />Qu. Sz. Cont. Color <br />Texture <br />Structure <br />Gr. Sz. Sh. <br />Consistence <br />Boundary <br />Roots <br />GPD/ff <br />*Eff#1 <br />*Eff#1 <br />*Eff#2 <br />% <br />O — `Y <br />7, S y i7 3/� <br />!S <br />/S <br />/--) J/) /<• <br /><f S <br />CS <br />3 An <br />-7 <br />46 <br />5'- !o j <br />73- Yl2 `x�zl <br />— <br />15 <br />s !, is <br />1 <br />(r S <br />-3 c e <br />% <br />/6- <br />C <br />3 <br />Boring # H Boring <br />MPit Ground surface elev. 96 .9 ft. Depth to limiting factor in. <br />Horizon <br />Depth <br />in. <br />Dominant Color <br />Munsell <br />Redox Description <br />Qu. Sz. Cont. Color <br />Texture <br />Structure <br />Gr. Sz. Sh. <br />Consistence <br />Boundary <br />Roots <br />GPD/ff <br />*Eff#1 <br />*Eff#2 <br />v- L1 <br />7.S5R-7/,X <br />-- <br />!S <br />/,,+7 s, 61c <br />I--, l <br /><f S <br />'_-r <br />. 7 <br />/. c— <br />�?n" s 6A <br />7.,1 / <br />G s <br />rn <br />7 <br />Clliuttlfll if I = DVU JU � LLU mg/L ano I bb >3U < 1bU mg/L " Effluent #2 = BOD ,:< 30 mg/L and TSS < 30 mg/L <br />CST Name (Please Print) Signature CST Number <br />Address Date Evaluation Conducted Telephone Number <br />-7 76 ,�i , 35- ??�i/��5�'-e cll-:Q o/.3 /O -JG -%� "7,s= �(�` Ll 7 <br />SBD -8330 (R07/13) <br />