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Wisconsin Department of Safety and Professional Services Page of <br /> Division of Industry Services csr- aD - 102 <br /> SOIL EVALUATION REPORT <br /> In accordance with SPS 385,Wis. Adm. Code County /n ' <br /> p <br /> Attach complete site plan on paper not less than 8 1/2 x 11 inches in size.Plan must include, Y <br /> but not limited to:vertical and horizontal reference point(BM),direction and percent slope, C �P5rcell D.d_ , _I&-34,--5-0.5""-001 4118/00 <br /> scale or dimensions,north arrow,and location and distance to nearest road. - <br /> y <br /> Please print all information. Revie ed lay /4144..........yOfill0 <br /> / <br /> Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). i <br /> Property Owner Property Location CO <br /> Pii.k! vo %/C>:, Govt.Lot '/4 '/4 S 36 T '1/ N R /C E (or) W <br /> Property Owner's Mailing Address Lot# Block# Subd.Name or CSM# <br /> 1?ds 7 i y0 ft. /q„8. N w I V.a 7 P 1 <br /> City State Zip Code Phone Number 0 Ci <br /> �0 vet- I/�N 15-5-369ty 0 Village ®Town Nearest Roada�9G-3.� <br /> ( ) I 11,-,/ss I minerVA Ch- <br /> ® New Construction Use:0 Residential/Numberof bedrooms y Code derived design flow rate ODOGPD <br /> 0 Replacement 0 Public elk commercial-Describe: <br /> Parent material ,16(•._40- ( 1✓r t f t Flood Plan elevation if applicable N/ ft. <br /> General comments and recommendations: <br /> Sys. elev chA•-5 <br /> / Boring# ID P tang Ground surface elev.95" <br /> ft. Depth to limiting factor>7� <br /> 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 /> ( o- L.1 -7,5-0 1/), — /i /,nsb%C rn I 6,s 3 n , 7 /. 6 <br /> d y- 3), -7.s`vz 1, -- ii ►mss b k <br /> 3 3,t- 6-. -7,5-117 -524, 5 0.S (t 65 3v o ; -7 /, 6 <br /> J. Boring# 0 Boring (IC' 7 73 <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. *EfF#1 *Eff#2 <br /> / 6'-41 7,syR3%t — /s /,n..5.4/. ,M l cs :?11 e7 1,6 <br /> 04 9- 33' -75'0 `44 f.S 1,,-736/ w, ) G�5 Sec , 7 /, 6 <br /> *Effluent#1 =BOD,>30 5 220 mg/L and TSS>30 5 150 mg/L *Effluent#2=BOD,>30 5 220 mg/L and TSS>30 5 150 mg/L <br /> CST Name(Please Print) Signat ,� ff CST Number <br /> ,pmts -sDGntve �_s S !/ i ) 73`1) <br /> Address of 770 /-/—), 3S' v Dat n Conducted Telephone Number <br /> t-t/,e 6 S/e /Air-sz ' (o <br /> i / 3 - / -- d E> '7s-- F06`Q/s7 <br /> SBD-8330(R04/15) <br />