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Wisconsin Department of Safety and Professional Services
<br /> Division of Industry Services CSR I G I N�. of
<br /> SOIL EVALUATION REPORT
<br /> in accordance with SPS 383,Wis. Adm. Code T 7 $ I
<br /> County
<br /> Attach complete site plan on paper not less than 8 1/2 x 11 inches in size.Plan must /3 t"4.
<br /> E
<br /> include,but not limited to:vertical and horizontal reference point(BM),direction and Parcel I.D. 7- -1 S .J" `y© -/`/`O3-5 /5'
<br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. _S`0,5`-_p.3/C'C O
<br /> Please print all information. Rp(�, ldeibyis ,X Date J
<br /> Personal information you provide may be used for secondary purposes(Privacy Law,s.15,04(1)(m)). v Wv" V �I /� C2``)7
<br /> Property Owner Property Location © ii
<br /> Cil"—f— I,(/E'}C/1 /er Govt.Lot 1/4 1/4 S ) T I/O N R /y E(or)W
<br /> Property Owner's Mailing Address Lot# Block# Subd. Name or CSM#
<br /> 3'61/ ni)17'5 lir, d 1
<br /> City State Zip Code Phone Number City 0 Village Town Nearest Road
<br /> /ilAd-56 i1 111/X I-CY 0 l b I ( )
<br /> ,.Sea# I Nc.,kC. N0/1i:v g(i')
<br /> EiNew Construction UseiT Residential I Number of bedrooms l Code derived design flow rate acv GPD
<br /> DReplacement / 0 Public or commercial-Describe:
<br /> Parent material G �,'z'/c / ar i(v
<br /> Flood Plain elevation if applicable /1//,Q ft.
<br /> General comments
<br /> and recommendations: 575, E'/e d,. C,1/. /
<br /> 0 Boring
<br /> Boring# ��
<br /> Q pit Ground surface elev. ft. Depth to limiting factor ) o E 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 /> / C'- `I 7.s--/R 36 — /S /in j,5/c: ,h I c: S 3 i>7 , 7 46,
<br /> ti- j ' 7,-3-'7/e `'�y I' d M SA/l r-, I a S 3 c a ; .S' /, 0
<br /> 3 1Y- 5,6 7,5-r/z '-/, 5 c',.5 , , ► 6 s ,07-7 • 7 / E
<br /> y LIG-5$4' 7,5''7? %y /fs c 5 G. ,.,., I — —
<br /> 3 /, 0
<br /> S Ss 4.6 7. `rfZ -7 S os l y,... I — . 7 /, 6
<br /> w,f 1, S'7/2 `1
<br /> �y � ,2_ ;; vf--"_ bfhaS
<br /> Eld. Boring# Boring
<br /> ® Pit Ground surface elev. 96. `r ft. Depth to limiting factor 6c in. I 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 /> / u • y 7 '73 Yid
<br /> J v-3 C .y/? `%y lFs
<br /> 3 36-y" ..'ti�7 f4i — /
<br /> `i' yv- 667srn %y iF-s ,); ,s4("< fr-,
<br /> *Effluent#1 =BODS>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) ......, CST Number
<br /> J6.w. r .5 S !�ur,c/s / `/ ) 73'0, ✓
<br /> Address Date Evaluation Conducted Telephone Number
<br /> d 7-7 G 77/,- / o-7-.5.- 11;'el, 5 / �' 3y:�
<br /> . c, - v s //- /y- / 7 '7/s- .5- ,- `r/s" 7
<br /> SI3D-8330(1207/13)
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