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Wisconsin Department of Safety and Professional Services R I G I N A L <br /> Division of Industry Services a <br /> SOIL EVALUATION REPO Page I 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 <br /> include,but not limited to:vertical and horizontal reference point(BM),direction and Parcel I.D.07—°ao -,A-'VO /�'1 -3 of <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. -000 - 0//apo <br /> Please print all information. vie ed by Date <br /> Personal information you provide may he used for secondary purposes(Privacy Law,s.15.04(1)(m)). <br /> Property Owner Property Location `7 <br /> HyI4 -5A ,at 9� Xravel Govt.Lot 1/4 1/4 S ,($ T yp N R /6 E(or)W <br /> Property Owner's Mailing Address ; LIA <br /> Block# Subd.Name or CSM# <br /> X760 ��- 33 37 4<,e5 �39037q <br /> City State Zip Code Phone Number ity ®village Il Town Nearest Road <br /> �f/-Ckiflve W. S'f8`7 3 ( 7/3 ) trliL- 41S7 le 1AP?0( 1 f/., ), .75- <br /> R New Construction LlseC] Residential/Number of bedrooms Code derived design flow rate /0 7s GPD <br /> ri Replacement FYI Public or commercial-Describe: 0,cr'e e 1,3rA.0 <br /> Parent material �rPr-f Flood Plain elevation if applicable <br /> General comments <br /> and recommendations: S1 f' e lC✓. <br /> Boring <br /> Boring# 9r/ s <br /> ri Pit Ground surface elev. ft. Depth to limiting factor > //d//d in. <br /> Soil Application Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff <br /> in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 *Eff#2 <br /> l 0 -yG S-//t -//G — S� X m / c s — -/ / 6 <br /> . -7 / 6 <br /> Boring# ® Boring <br /> ❑X Pit Ground surface elev. ` AY. a ft. Depth to limiting factor > 164 in. <br /> Soil Application Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff <br /> in. Munsell Qu.Sz Cont.Color Gr.Sz.Sh. *Eff#1 *Eff#2 <br /> R 4/1f <br /> 3 yh'- 70 7-1-1/T <br /> Effluent#1 =BOD >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 /> Jet „, es S, /�A/1/-elf SI�A�� a7'3ilh0 <br /> Address V Date Evaluation Conducted Telephone Number <br /> ,177Ga A4.. 3-4 / 1-e,6sfY, 1-'l 5-X18'13 7, 71 ,- BGG -y/s-7 <br /> SBD-8330(807/13) <br />