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Wisconsin Department of Safety and Professional Services <br /> Division of Industry Services <br /> SOIL EVALUATION REPORT Page of <br /> in accordance with SPS 383,Wis. Adm. Code <br /> County $URNETT <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 I.D.0 -7 O V '�2 'R� y <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. 0 y 000 pllpQ o <br /> Please print all information. a �ewed lb D t 194 <br /> 1� <br /> Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). <br /> Property Owner Property Location c '- <br /> Aidel Govt.Lot S 1/4567- 4 Sa T N R/9' E(or)W <br /> Property Owner's Mailing Address Lot# Block# SUbn.lgMr -nn rQ1'" <br /> -2,32, 77 C � > <br /> City State Zip Code Phone Number El <br /> ity 0 Villa e Is town V Nearest Road �3.-Z 7" <br /> g <br /> 3l-IlS <br /> E] New Construction UsejS Residential/Number of bedrooms Code derived design flow rate �7r�C7 GPD <br /> Replacement F1 I Public or commercial-Describe: —" <br /> Parent material G�119"C i.4 f 7-- Flood Plain elevation if applicable /7 } ft. <br /> General comments <br /> and recommendations: <br /> F/-1 Boring <br /> Boring# El <br /> Pit Ground surface elev.�ft. Depth to limiting factor in. 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 /> 3 17 lC <br /> F51Boring# R Boring C <br /> El Pit Ground surface elev. 7/7, (f" ft. Depth to limiting factor 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 /> 715V 7/ <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 /> Wade Rufsholme- �� 227691 <br /> Address Date Evaluation Conducted Telephone Number <br /> P®Box 514,Siren,W154872 c. _ cj (715)349-7286 <br /> SBD-8330(R07/13) <br />