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, Wisconsin Department of Safety and Professional Services � ��1 Page of <br /> Division of Industry Services ` <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. <br /> scale or dimensions, north arrow,and location and distance to nearest road. O I O '�� '174-3 a �� ol <br /> iCOD <br /> Please print all information. Revi__e-d•�y (;)/0/2 <br /> Personal information youprovide maybe used for secondarypurposes(PrivacyLaw,s. 15.04(1)(m)). I /� l O�o <br /> P P <br /> Prop(ert Owner / Property Location 1=Ii(I tf�t/ ..... <br /> Govt. Lot '/< 'A< S (I T N R t2 E (or) W <br /> PrrygpertyryOwner's Mailing <br /> �Address^j Lot# Block# Subd. Name or CSM# <br /> 6') 1 CLS '''.v\ 12✓ Y <br /> City StateZip Code Phone Number ❑ City ❑Village ['Town Nearest Road a3ait <br /> D�t3STI a I a 1 zietfi 3 I ( "3(3 )<Ill,?7,' I I 4J . I 10 <br /> ❑ New Construction Use:0 Residential/Number of bedrooms Z Code derived design flow rate/ZLv 3PD <br /> [''Replacement ❑ Public or commercial-Describe: <br /> Parent material (i)Lac {21LT Flood Plan elevation if applicable ft. <br /> General comments and recommendations: <br /> viz 1)2o ,zry (-7012 it? P& -tL i Zu, PP <br /> / <br /> Boring# 0 Boring <br /> 2'Pit Ground surface elev.9'7 4'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 /> I (:.:- 14 j ,. Z/Z - L5 1A i414 you/a C Zuc-►i °1 I- b <br /> 2 14 - 30 10,1„- y/q _ LS 1ii15�t d I (.'s Ztikc) -•1 `.4 <br /> 3 3v- ..'' i 3// - Gal--i' OS d, G) VP . r) I'L <br /> 1 5► -` ✓ (vil _- C56, wig C6 I.1 <br /> 2 Boring# 0 Boring Cit+ [� n <br /> E rPit Ground surface elev. (-1 1 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 /> 1 ( ►li 1 L5 I ASA At\V►a. . C 4S-i1 . 1 <br /> 7 H- t 114 Li OS6, d.L C) 24J C.o ,'1 j.te <br /> 3 25- f 314 - ( llgS CXJ AL GS vi- ,1 I-iv <br /> �Y� \D( G/,�_ — . S A-- 6,5 - /1 i_(2 <br /> 5 T - fl t c , 4/y C Z.0 .i 7✓ y�i 5 Z i31z A L (35 <br /> *Effluent#1 =BOD,>30<_220 mg/L and TSS>3 <_150 /l. *Effluent#2=BOD,>30<_220 mg/L and TSS>30<_150 mg/L <br /> CST Nang(Please�fint) (t.i9,\ Signat rA CST I lumber <br /> Address Date v uatio Conducted <br /> (1 � L n' Telephone Number <br /> 3`u b(qc. it J, (e- - 2oZO '7/S 0;/ W(.6' <br /> 's,-�' ] �, S-414 c 3 SBD-8330(R04/15) <br />