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Wisconsin Department of Safety and Professional ServicesPage 1 of 3 <br /> Division of Industry Services e..s-r-x - 112 <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, O <br /> but not limited to:vertical and horizontal reference point(BM),direction and percent slope, Parcel I.D. CO <br /> CCCI <br /> scale or dimensions,north arrow,and location and distance to nearest road. 21/A32 S 2 LI <br /> Please print all information. evie d b+y ` Da <br /> Personal information you provide may be used for secondary purposes(Privacy Law,S.15.04(1)(m)). 1� 6/24 <br /> 2.16 <br /> Property Owner Property Location <br /> 1 i X e L(.4 C), I G c 2 Govt.Lot 6 c 1/44)4/1/4 S )3 T1-10 N R )5— E (or) W <br /> Property Owner's ailin Address ,/� Lot# Block# Subd. Name or CSM#/ eir <br /> 36253 L�.P! Lodfie L'� 57 Oe,7Lodge_ f�dl,' 1© 1/ a9 <br /> 9tx State Zip Coe Phone Number ❑City 0 Village Town Nearest Road <br /> Lk, 4b'( r S° ' I V1 I S I (7!s)s ?3 1g7c I I <Ac,501 Deer rbet-- <br /> El New Construction Use: (Residential/Number of bedrooms 7 Code derived design flow rate-7-Q')GPD <br /> XReplacement 0 Public or commercial-Describe: <br /> Parent material C)I G G '01 1 Ti 1 r Flood Plan elevation if applicable Ai ft. <br /> General comments and recommendations: 75- <br /> � e E / 6 � <br /> ,.8. ---(N.---(N.o l I S 5, ,,� .� l0 <br /> ) Boring# Boring rry c�z <br /> Pit Ground surface elev. / ft. Depth to limiting factot%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 C7-- 75�,,�'y �� 2Ms, MP Cg 7 , 6 1. 0 <br /> 2 -?,-13. 7 s),�i� L_5 )41 9$ ,f, CS -- , '7 I. <br /> ,,,,t <br /> IY- 1C -7. 16e.A <br /> 0 5. ci. '7 L _ — , .7 i 6. <br /> .� -0 Boring ad Q <br /> Boring# 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 /> ik D-,1'1 . v /f ,/y/A '` �s� M F Zf = z /.0 <br /> 2 e-i CU 7,5, 4 yS A 2F Irk <br /> 1 70'- -3 f / .. 050 .��- -- — . 7 1. C <br /> *Effluent#1 =BOD,>30 s 220 mg/L and TSS>30 5 150 mg/L *Effluent#2=BOD,>30 5 220 mg/L and TSS>30 s 150 mg/L <br /> rCN+e(Ple,�se Print)ofC%2 Signatu � /f <br /> gtymber <br /> Ad_dr ss A A Date alu tion Gird Telephone Number <br /> W 7003 lD a to,y �G /-, a-- -I-- b7151---5,0-23 <br /> �5 <br /> T e 9 0 ^./ + 722 SBD-8330(R04/15) <br />