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Wisconsin Department of Safety and Professional Services ORIGINAL <br />Division of Industry Services <br />SOIL EVALUATION REPORT 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 <br />include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel <br />percent slope, scale or dimensions, north arrow, and location and distance to nearest road. 5". o – 0_5-g0C)0 <br />Please print all information. Fliewed by Date <br />Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). <br />Property Owner sl -e <br />Location <br />14 %t'-ev1 H e o S t "e Y Govt. Lot 1/4 1/4 S 7 T �/Q N R /� ®r)® <br />Property <br />Owner's Mailing Address Lot # Block # Subd. Name or CSM# <br />q Cl <br />City State Zip Code Phone Number ity ❑ Village VITown Nearest Roada ff it <br />rl New Construction Useq] Residential / Number of bedrooms_ Code derived design flow rate GPD <br />Replacement rl Public or commercial - Describe: <br />Parent material 4570 cl eL ( 1)"-1eY- Flood Plain elevation if applicable <br />General comments <br />and recommendations: y 7 QL feprf>L S�lae14941 71 <br />Boring # <br />1 0 Boring <br />rM <br />r, 1Pit Ground surface elev. J g 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#1 <br />*Eff#2 <br />v ti <br />a- 2 <br />-- <br />/S <br />IS <br />"ll <br />3 <br />. `7 <br />46 <br />'- 3Y <br />-7, <br />15 <br />S <br />,y,S #+� <br />h, I <br />S <br />3 co <br />-7 <br />1.6 <br />-3E�•So <br />7.5 �/zy/ <br />osd <br />► <br />GS <br />n� <br />.� <br />14 <br />Ll <br />-75� <br />, s- 71e;g <br />S <br />a �G <br />N, r <br />— <br />- <br />, 7 <br />1.6 <br />I �] Boring # Lj Boring <br />Q pit Ground surface elev. 196,0 ft. Depth to limiting factor y in. <br />Horizon <br />Depth <br />in. <br />Dominant Color <br />Munsell <br />Redox Description <br />Cu. Sz. Cont. Color <br />Texture <br />Structure <br />Gr. Sz. Sh. <br />Consistence <br />Boundary <br />Roots <br />a« <br />GPD/ff <br />*Eff#1 <br />*Eff#2 <br />v ti <br />'7,-s 1k <br />-- <br />/S <br />h.7-56 k <br />"ll <br />7 <br />/, 6 <br />7.5 `TR v/`j <br />— <br />15 <br />Am is ie <br />7 <br />1,6 <br />3 <br />-3E�•So <br />7.5 �/zy/ <br />osd <br />► <br />GS <br />n� <br />.� <br />14 <br />7 <br />46 <br />cmuci a rr I – DUu - ou < «u mgic ana i as >au < -i!)U mgiu ` Effluent #2 = BCD5:< 30 mg/L and TSS < 30 mg/L <br />CST Name (Please Pnnt)ign�atu/Jr � �� /^ CST Number <br />w <br />Ja , es s 0a ►Y / j ly /.j p <br />Address Date Evaluation Conducted Telephone Number <br />)-7:76e #-v y S- I -M -745= :?GG- 4/1,5-7 <br />SBD -8330 (807/13) <br />