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Wisconsin Department of Safety and Professional Services of <br /> Division of Industry Services CAT—;74-/3 j> <br /> SOIL EVALUATION REPORT <br /> In accordance with SPS 385,Wis. Adm. Code County <br /> /3Lt.VhN Tf <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. 07-c d:0~,1-110--/‘•-o5t-5-4-"- <br /> scale or dimensions,north arrow,and location and distance to nearest road. LOC- 04,,00 r' <br /> Please print all information. . "evie ed tsy D t /��� <br /> Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). (/ <br /> Property Owner Property Location ❑ 0 <br /> rA d r iC D;i b`Ii Govt.Lot '/4 1/4 S q T 90 N R ie E (or) W <br /> Property Owner's Mailing Address Lot# Block# Subd.Name or CSM# <br /> 653,6 "30 4-1^ .St 34 681,5-/ <br /> City Zip Code Phone Number 0 City 0 Village <br /> hg ❑Town Nearest Road <br /> Ct# � 7 <br /> Sc Grove Iill"I I550!6 1 ( ) 1 1 (-5c--14+vrc+l (tor), /44yolcm 4h <br /> ® New Construction Use:Q Residential/Numberof bedrooms -I Code derived design flow rate`/CC GPD <br /> 0 Replacement 0 Public or commercial-Describe: l <br /> Parent material 6 l ace r O' i'It- Flood Plan elevation if applicable A(`� ft. <br /> General comments and recommendations: <br /> Sys e 1-ev. . , 5 <br /> Boring# 0 Boring q 7.5' <br /> ®Pit Ground surface elev. if• ft. Depth to limiting factor A 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 /> C- 9 7,_5-TZ 34 ..,_ / S %rrx S 4 k r-t, 1 C: S 3n n , 7 /.f'o <br /> i/- !q 7,s`IR "'Ai if tim5614 w+ I c 5 :3Ce # 7 <br /> /.6 <br /> 3 i 5- 50 7.5 y/7 V6 5 6S I- ,.,.i. t rs 5 ,t m , 7 /. 6 <br /> LY j'o- 7 q 7,5'71?-74 — .s 6 S 6- i,.•. 1 — 71-7-- ,7 /,4, <br /> P Boring# ©Boring 9'11 ( 75 <br /> 0 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 /> 1- .o .7,5-`7K`4/ti -- , .s . 7 /, 6 <br /> 3 a 4/6 7,5-V i? ``/� •7 /,6 <br /> L/ 96 7s -7. ./7% .s �- ='� + 7 <br /> X. 6 <br /> *Effluent#1 =BOD,>30 5 220 mg/L and TSS>30 5 150 mg/L *Effluent#2=BOD,>30<_220 mg/L and TSS>30 5 150 mg/L <br /> CST Name(Please Print) Signatu e CST Number <br /> Ja�Y� s Oai7/-els � S.l-2�,...4 �7,1NGAG <br /> Address 17760 Hi-.Y - Dat valuation Conducted Telephone Number <br /> t,✓t1a,0trY w? ✓ 3 7- .2 6 - / 9 7%5= qc 6- 4/3-7 <br /> SBD-8330(R04/15) <br />