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Wisconsin Department of Safety and Professional Services ORIGINAL <br />Division of Industry Services <br />SOIL EVALUATION REPOR , Page of <br />in accordance with SPS 383, Wis. Adm. Code J �' <br />County <br />Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan musts �' n <br />include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. 07 - 01 Y-1' 3 <br />percent slope, scale or dimensions, north arrow, and location and distance to nearest road. A c)oC) <br />Please print all information. Re law d by Date <br />P (Privacy �) � )) C7,/ <br />Personal information you provide may be used for secondary purposes Privac Law, s. 15.04 1 m . <br />Property Owner Property Location El El <br />Ha r V Y 11-e- fC ✓1 le r Govt. Lot 1/4 1/4 S )S T ? i N R iG E (or) W <br />Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# <br />City State Zip Code Phone Number IL-Jity ❑ Village X s Town Nearest Road <br />IL1),�le , 1,e5 763 M M <br />New Construction Usee Residential / Number of bedrooms <br />nReplacement n Public or commercial - Describe: . <br />Parent material " I /D ✓'r {'i" <br />General comments �� c <br />and recommendations: Sy S. <br />A Code derived design flow rate -?oO <br />GPD <br />Flood Plain elevation if applicable /y%/% ft. <br />❑ Boring # Boring <br />�i'S. <br />Pit Ground surfaceelev, ft. Depth to limiting factor 3�0 in. <br />Cnil 4nnlinoHnn Dn4n <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 />I *Eff#2 <br />/ <br />6—& <br />-7 5- -/ /7 3 /u, <br />— <br />/S <br />lin 5' 6 /< <br />Zr / <br />7 <br />l � <br />of <br />:3o <br />7, 5-VA?4/,-1 <br />/�✓` <br />plsns6A- <br />ih 1 <br />�, 5 <br />S._ <br />3 <br />3e-39 <br />7s 9/? <br />P-1 <br />Boring # L Boring <br />Pit Ground surface elev. gy 3' ft. Depth to limiting factor d 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/f? <br />*Effi#1 <br />*Eff#2 <br />/ <br />o- 6 <br />-7, s11R -'/,( <br />— <br />/--:( <br />/m sd j< <br />Zr / <br />7 <br />/ E <br />3 <br />cmuem i i = rsvu5 > Ju < zzu mg/L ano 155 >30 <I 5U mg/L ' Effluent #2 = BOD,:5 30 mg/L and TSS < 30 mg/L <br />CST Name (Please Print) Signature CST Number <br />/2�t <br />Address Date Evaluation Conducted Telephone Number <br />a 7 76 0 /44y3S/�/p/s'fr GU?"� y�3 //-7- <br />A <br />/-7` <br />SBD -8330 (807/13) <br />