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Wisconsin Department of Safety and Professional Services ORIGINAL <br /> Division of Industry Services <br /> SOIL EVALUATION REPORT I�_ Page_of_ <br /> in accordance with SPS 383,Wis. Adm. Code <br /> r n _ <br /> Attach complete site plan on paper not less than 81/2 x 11 inches in size.Plan must County Fµ <br /> include,but not limited to:vertical and horizontal reference point(BM),direction and Parcel I.D.07—0d H-d'3 4— 19—0 8-1 0 d <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. Q p0 — 0 1 1 60 0 <br /> Please print all information. d by Dat <br /> ;CIA <br /> e <br /> Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). / Q)l)S <br /> Property Owner Property Location ® Ul <br /> /Zr1-4y Dr...50IS Govt.Lot 1/4 1/4 S 9 T 39 N R /y E(or)W <br /> Property Owner's Mailing Address Lot# Block# Subd.Name or CSM# <br /> 5'Oa, A)- fnAIW'11 1 3 033 <br /> City State Zip Code Phone Number []City ❑Village Town Nearest Road <br /> 1437 <br /> Fa innaht M/✓ fbv3! I ( 1) yp8—d3by l?�.S k Gast n CK /?c/ <br /> New Construction LlseE] Residential/Number of bedrooms 3 Code derived design flow rate X/4-0 GPD <br /> nReplacement ❑ Public or commercial-Describe: <br /> Parent material Gla e is ! !/r tirf Flood Plain elevation if applicable A1114 fL <br /> General comments <br /> and recommendations: S y,f. 2 t-e✓• U p r 93, O <br /> !ower 9,,.5 <br /> /❑ ❑ Boring Boring# <br /> Pit Ground surface elev. 95.5 ft. Depth to limiting factor 7 71el in. <br /> Soil Application Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fe <br /> in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 `Eff#2 <br /> o-/s 7.syn �� — /s 4"S,6/e I cs F 7 A6 <br /> JS--- 7.Stil� `''/ -Ks Mss/c 3Co ..5" /• O <br /> 3 36-7Y 7..sAIR%y -- S a,, f6X — a M S <br /> WN1 /r1 7.5- V-1171s AAn ./,s <br /> Boring# ❑ Boring <br /> ® Pit Ground surface elev. //r. 6 ft. Depth to limiting factor_ 7 8/ in. Soil Application Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' <br /> in. Munsell Cu.Sz. Cont.Color Gr.Sz.Sh. -Eff#1 -Eff#2 <br /> JL l�. HO 7.5-'4/9 '/42 /jf:�S dms6 /e .-� I 0!� S 3Co .S /. 0 <br /> 3 Ho- �v7•Sy/? Y/ — /re's dAlb k- I l 65.5 IJ <br /> Effluent#1 =BOD >30<220 mg/L and TSS>30<150 mg/L 'Effluent#2=BOD,:5 30 mg/L and TSS:S 30 mg/L <br /> CST Name (Please Print) Signature CST Number <br /> J a�, s .s v�h, /s i 7.3 40? O <br /> Address V Date Evaluation Conducted Telephone Number <br /> SBD-8330(R07/13) <br />