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Wisconsin Department of Safety and Professional Services Page of <br /> Division of Industry Services !�-1-"' <br /> "' —14e <br /> SOIL EVALUATION REPORT <br /> In accordance with SPS 385,Wis. Adm. Code County l� <br /> Attach complete site plan on paper not less than 8 1/2 x 11 inches in size.Plan must include, " `~Y n <br /> but not limited to:vertical and horizontal reference point(BM),direction and percent slope, Parcel I.D. ,..�Cj--/4.-3%-S 03-Datil <br /> scale or dimensions,north arrow,and location and distance to nearest road. 0 7' _0010" b lac/00 <br /> Please print all information. �y'evie cjJDat <br /> Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). o9, ($f/20201 <br /> Property Owner Property/VA. Property Location 0 <br /> 12 <br /> '�'l ;C �Ai_j1-fL r•,./1 Govt.Lot 61 '/ 1/ S 3 J T y0 N R /6 E (or) W <br /> Property Owner's Mailing Address Lot# Block# Subd.Name or CSM# <br /> 4 7.1i/ 57LAt,. /2d 3 5— <br /> City <br /> City State Zip Code Phone Number 0 City 0 Village ®Town Nearest Road .17.1rz/ <br /> t'z°ks- ✓ 1L'tr I.5-y673 I ( ) I I 0a.I4.:144,1rl I Jo.nirsctl gel. <br /> N New Construction Use:®Residential/Numberof bedrooms 3 Code derived design flow rate. '-/.5'GPD <br /> 0 Replacement 0 Public or commercial-Describe: , <br /> Parent material i I R�-t'- 1 !� ,{� Flood Plan elevation if applicable AY/it. <br /> tt. <br /> General comments and recommendations: 5. j 't I)-e le 9't. .5 <br /> y t, /64 wee °l't. 0 <br /> Boring# ❑�. Boring 9 4,, <br /> .7 70 <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 0, - 1-I 7,3YR �,n /.3 . 7 / 6 <br /> 4 y lsi -7.s.--ti? y/y -- 9s _ 7 /6 <br /> 3 1'7-s-d. -7 $`7? �/y 5 _ 7 /. ' <br /> `y Sd- 70 —7—s"—tit -7, — .5 <br /> i Boring# ❑Boring ��� 7 <br /> ado <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 /> I 0 - y 7.3-'lit 3/A /.S 1 ,shk. yh ! c5 3 :", , 7 /, 6 <br /> ,,1 `1- is' 7.3-'ii? y/i S ,A.rI 3 é /z r•-, I (S 3 00 • 7 / 6 <br /> 3 /3'-5-y 73-^i/ -,/ii -- 3 o5 6 ,i. I C' . ,,t to , 7 /, 4 <br /> `l sy- '7V -73-91?7't -- S of(- ,..„, 1 — — . 7 /, 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) Signature / �f CST Number <br /> R 21 c-1 e �I a n le i h S• / 1-�t�"i // ��- �,�,-5 c J/ <br /> Address )7 760 ///' 33— Date Evaluation Conducted Telephone Number <br /> WL6s e v/13- _cif Y93 7- ,Zi -- .)0 -2r:S= 566 — �/s7 <br /> SBD-8330(R04/15) <br />