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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 I�_) <br />r h f <br />Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County lot, W-- <br />include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D.o7 <br />percent slope, scale or dimensions, north arrow, and location and distance to nearest road. y f0 o 41go&C <br />Please print all information. Rev'Zby Date <br />Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). "-- <br />Property Owner Property Location <br />F,,L r I, Govt. Lot 1/4 1/4 S "7 T z/0 N R / y E (or) W <br />Property Owner's Mailing Address �gj <br />Blo!Mf <br />. N e or CSM# <br />pe. jx <br />City State Zip Code Phone Number : Town Nearest Road 3410/ <br />M es 4- 1AZ 11-5-j 18 ( � Sc©7`i` 04-e Ad -v t,, /?c� <br />New Construction <br />UseEj Residential / Number of bedrooms 3 Code derived design flow rate G%S'U GPD <br />Replacement <br />n Public or commercial - Describe: <br />Parent material <br />G t k / Dr f 6L Flood Plain elevation if applicable ft. <br />General commentss, <br />s mho e P^ �S. O <br />and recommendations: rn 9 iy, .7 <br />&4, 0eA�" "aad. <br />' 16Ad1ny <br />,- 106v✓V <br />Boring <br />F <br />Boring # <br />Pit Ground surface elev. !�/ ft. Depth to limiting factor i 7Z7 in. <br />Qnil Annlirofinn Rafa <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#2 <br />*Eff#1 <br />*Eff#2 <br />-- <br />/s /M.sb k <br />) <br />C s <br />3 F <br />b/c <br />/ 6 <br />d 1e Sd <br />-7.5-tii?'�%fo <br />--- <br />If'� �imsd/< <br />>". l <br />�8 <br />7.� yi2 4l <br />— <br />PFS <br />c1 in sb /< <br />/ <br />t' <br />(/2r <br />Lb its <br />v <br />®Boring # U Boring <br />Pit Ground surface elev. 9 7" zi ft. Depth to limiting factor in. Cnil A—H—fi— P <br />Horizon Depth <br />in. <br />Dominant Color <br />Munsell <br />Redox Description <br />Qu. Sz. Cont. Color <br />Texture Structure <br />Gr. Sz. Sh. <br />Consistence <br />Boundary <br />Roots <br />GPD/ff <br />*Eff#1 <br />*Eff#2 <br />7, s`i/7 "11,( <br />-- <br />/s /M.sb k <br />) <br />C s <br />3 F <br />17 <br />/ 6 <br />d 1e Sd <br />-7.5-tii?'�%fo <br />--- <br />If'� �imsd/< <br />>". l <br />66 <br />J vt= <br />15— <br />40 <br />/ <br />t' <br />. Effluent #1 = BODS > 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) Signature CST Number <br />JA t-" Ws .S /�a��/�%s �2i.v✓� S (i ,173410 0 <br />Address Date Evaluation Conducted Telephone Number <br />7 76 n /SC. 3� �, s / Gam" �-v �3 //2- /7 -71,s -- �6- yis 7 <br />SBD -8330 (R07/13) <br />