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Wisconsin Department of Safety and Professional Services ��-7 Page of <br /> Division of Industry Services (_ J l,7 -v l <br /> SOIL EVALUATION REPORT <br /> In accordance with SPS 385,Wis. Adm. Code County <br /> Attach complete site plan on paper not less than 8 1/2 x 11 inches in size.Plan must include, <br /> but not limited to:vertical and horizontal reference point(BM),direction and percent slope, Parcel I.D.07- t 0—A-Lt)�IS- ;t- 13 <br /> scale or dimensions,north arrow,and location and distance to nearest road. �Sj- /03 0pQ <br /> Please print all information. R vie b Date <br /> Personal information you provide may be used for secondary purposes Privacy Law,s.15.04 1 m . 3-!/-19 <br /> Property Owner Property Location ❑ <br /> El <br /> •(n h L' 1-15'101 Govt.Lot Y< Y< S %P/ T 4() N R /5S- E (or) W <br /> Pro erty Owner's Mailing Address Lot# Block# Subd.Name or CSM# <br /> T 3,A S vN Ave 9& <br /> City State Zip Code Phone Number ❑city El Village ❑Town Nearest Road )Yyz/ rt <br /> vt O K4- lf,N S:5--30.3 .� c K s e IeW <br /> ❑ New Construction Use:®Residential/Number of bedrooms 9� Code derived design flow rate GPD <br /> Replacement ❑Public or commercial-Describe: <br /> Parent material C/6Z.r ( d"r- r Flood Plan elevation if applicable, �,. ft. <br /> General comments and recommendations: jy� /et..' <br /> Boring# ❑Boring { 5 7 <br /> ®Pit Ground surface elev. ft. Depth to limiting factor in. <br /> Soil Application Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/Ft2 <br /> In. Munsell Qu.Az.Cont.Color Gr.Sz.Sh. *Eff#1 *Eff#2 <br /> - 4 ZLI X'1/ -- /s %InAk in f C S 31" , 7 46 <br /> JA -3 y 7 tz 414• — /FS d eb 1, 6: <br /> 3 3Y-6 0 75-117 /y — {FS <br /> ❑ Boring# ❑Boring c�N,Fi 7'fir( <br /> Q Pit Ground surface elev. ft. Depth to limiting factor in. <br /> Soil Application Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/Ft2 <br /> In. Munsell Qu.Az.Cont.Color Gr.Sz.Sh. *Eff#1 *Eff#2 <br /> /-5, Jm s b K ;ter 1 CS Sin .-7 <br /> .� Y- 3 S`l1Z `'/6 1t"S dm3'b%c <br /> 3 36 Srl?`/ - S ,ems b K v-, 1 tz z►'I .S <br /> I, G <br /> y-7,4 7S-y17 �/ <br /> *Effluent#1 =BOD,>30 5 220 m /L and TSS>30 15 150 m /L *Effluent#2=BOD,>30 15 220 m /L and TSS>30 5 150 m /L <br /> CST Name(Please Print) Signs re CST Number <br /> JA wr-es <br /> Address )77 0 Y r Dat Evaluation Conducted Telephone Number <br /> SBD-8330(R04/15) <br />