Laserfiche WebLink
Wisconsin Department of Safety and Professional Services <br />Division of industry Services � R I G i NA L�age of <br />SOIL EVALUATION REPO <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 BUR "E C: _ r t0 <br />include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. 0 F -0 0 / S% / 9 5 0 <br />percent slope, scale or dimensions, north arrow, and location and distance to nearest road. e5c>3 ql7000 <br />Please print all information.Revi d b Date <br />Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). <br />Property Owner Property Locations <br />G G�0/ 1�e e ��p Govt. Lot 3 1/4 1/4 S T "/0 N R/ y Or <br />W <br />Property Owner's 7'We'+5Ar') <br />Address Lot # Block # bbd-Aler—e or CSM# <br />G 9.3 3 f Z -N, j — / /6 -- <br />city <br />5'City 1 State Zip Code Phone Number ,City OVillage MTown Nearest Road '31414D <br />GeA)1 eN�e. 4 15503 0�5 ) 3,2 a38'-2 .�c-o- — l �rorkq <br />C <br />� <br />New Construction Use ; Residential / Number of bedrooms , �_ Code derived design flow rate GPD <br />Replacement Public or commercial - Describe: <br />Parent material C 7- lA4-G -jCe Flood Plain elevation if applicable ft. <br />General comments <br />and recommendations: <br />1-11 M Boring # Boring L., <br />Pit Ground surface elev. 97, 1 ft. Depth to limiting factor 3q in. <br />Horizon Depth <br />in. <br />Dominant Color Redox Description <br />Munsell Qu. Sz. Cont. Color <br />Texture <br />Structure Consistence Boundary Roots <br />Gr. Sz. Sh. <br />a« <br />GPD/ft <br />*Eff#1 <br />*Eff#2 <br />1 0- <br />7,az <br />Munsell <br />7r <br />Qu. Sz. Cont. Color <br />1.5 <br />S- <br />-7, <br />*Eff#1 <br />*Eff#2 <br />-3S <br />///��` <br />/ S V �% <br />G� <br />�0 <br />1,6 <br />116 <br />15-1yo7. <br />y/ <br />G a/ e � <br />-fS <br />rn 5114 <br />Boring # Lj Boring <br />Pit Ground surface elev. 7i ft. Depth to limiting factor_ in. <br />Soil Application Rate <br />Horizon Depth <br />Dominant Color <br />Redox Description <br />Texture <br />Structure Consistence <br />Boundary <br />Roots <br />GPD/fi <br />in./ <br />I 0 <br />Munsell <br />7r <br />Qu. Sz. Cont. Color <br />1.5 <br />Gr. Sz. SSh. <br />/l h k <br />*Eff#1 <br />*Eff#2 <br />-3S <br />///��` <br />/ S V �% <br />G� <br />�0 <br />1,6 <br />116 <br />15-1yo7. <br />y/ <br />G a/ e � <br />-fS <br />rn 5114 <br />* Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mg/L <br />CST Name (Please Print)),Signature <br />Wade Rufsholm /— -1014, <br />Address <br />PO Box 514, Siren, W154872 <br />* Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L <br />4 <br />CST Number <br />4"04— 227691 <br />Date Evaluation Conducted Telephone Number <br />(715) 349-7286 <br />SBD -8330 (R07/13) <br />