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Wisconsin Department of Safety and Professional Services Page of <br /> Division of Industry Services Gs f� 19-I(4 <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, �1A V M 'e <br /> but not limited to:vertical and horizontal reference point(BM),direction and percent slope, Parcel LD.p7-G lot-d-'/0-/S-oZ�-SAS-v0 <br /> scale or dimensions,north arrow,and location and distance to nearest road. 013 600 <br /> Please print all information. ew wed-byf D e <br /> Personal information you provide may be used for secondary purposes Privacy Law,s.15.04(1)m <br /> Property Owner Property Location <br /> f'Yl G C 0 M b,e✓ Govt.Lot 7 '/< /< S ,(g T 90 N R 1S- E (or) W <br /> Property Owner's Mailing Address Lot#6 Block# Subd.Name or CSM# <br /> 737 S7:,,Ir w:llta14s Dr. V. tf P So <br /> City State Zip Code Phone Nfnher <br /> V✓ 8/a ffY, Gt/_ _f f 3 3 of ❑city ❑Village ®Town Nearest Road <br /> 71f- 03/$ .,aL<<Ser► �,rr�a�Bv 17aQ <br /> © New Construction Use:©Residential/Number of bedrooms Code derived design flow rate 45 y GPD <br /> ❑ Replacement ❑Public or co mercial-Describe: <br /> Parent material / L) Flood Plan elevation if applicable IV/19 ft. <br /> General comments and recommendations: <br /> Sys el:°d 5 4•H to 97 6 <br /> © Boring# ❑Boring 98 4, 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. <br /> *Eff#1 *Eff#2 <br /> O-? 7S`7R 34 — 9S m S bld rw. I G S 3M ,-7 /, b <br /> r,% <br /> 3 15--J. 5`7/Z"/'Y IVFS 4► $61e . `1 , 6 <br /> -7 7s7R y fFS ms6/� ► — 1 F S� .b <br /> ® Boring# ❑Boring 7.( <br /> Pit Ground surface elev96'7 ft. Depth to limiting factor ? in. <br /> Soil Application Rate <br /> Horizon Depth Dominant ColorMZJ�'f.Ale <br /> Structure Consistence Boundary Roots GPD/Ft2 <br /> In. Munsell J Gr.Sz.Sh. <br /> d- 6 7,S7R�/ �MS�/� rn ) *Eff#1 *Eff#2 <br /> 6- 33 7-7 wlz "/G <br /> ► G S Teo <br /> 33- SR sw1Z `*/(, — IFS ol,ns5k r..1 5 �m S� /• o <br /> S Y--7� 7sy1Z <br /> *Effluent#1 =BOD,>30<_220 mg/L and TSS>30<150 mg/L *Effluent#2=BOD,>30 s 220 mg/L and TSS>30 s 150 m /L <br /> CST Name(Please Print) Signs re CST Number <br /> J o t+-7 S�2c. r� �> f/ 7-3 0/ U <br /> Address ) 77G Dat valuation Conducted Telephone Number <br /> SBD-8330(R04/15) <br />