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Wisconsin Department of Safety and Professional Services Page of <br /> Division of Industry Services 0 T p90"I(. <br /> SOIL EVALUATION REPORT <br /> In accordance with SPS 385,Wis. Adm. Code County r� <br /> it- <br /> Attach complete site plan on paper not less than 8 1/2 x 11 inches in size.Plan must include, (J C4-•r n <br /> e <br /> but not limited to:vertical and horizontal reference point(BM),direction and percent slope, Parcel t.D. qo./6,-/9-5 15---3e0 <br /> scale or dimensions,north arrow,and location and distance to nearest road. o7-O. D �� _ /O5 %' <br /> Please print all information. evi eciby 40420 <br /> Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). <br /> Property Owner Property Location ❑ El <br /> 66,y.y Pay/ hj Govt.Lot y 1/4 1/4 S /`j T 7'0 N R/E2 E (or) W <br /> Property Owner's Mailing Address Lot# Block# Subd.Name or CSM# <br /> 57601 pk.-leS1- V ,1t P 3/ <br /> City State Zip Code Phone Number 0 City 0 Village 2 Town Nearest Road S©LSO <br /> , H4u•Y I tr 1.5-Ye30 I ( ) I I 461clw.ol I p6,-IS s74- <br /> la New Construction Use:2 Residential/Numberof bedrooms .3 Code derived design flow rate ysOGPD <br /> 0 Replacement 0 Public or commercial-Describe: <br /> Parent material '/l Gi G( Dr"i tFlood Plan elevation if •applicable 4/)ft. <br /> General comments and recommendations: <br /> Syj e/se v CHS" <br /> Boring# <br /> 0 Boring© 96 L� �Pit Ground surface elev. ft. Depth to limiting factor I' c')rn. <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. <br /> *Eff#1 *Eff#2 <br /> d ii ��S`//'Z 36. ...... <br /> /5 /wns.b K 1-v11 6.S 301;i; , '7 /, 6, <br /> 04 y-3? '7,s7' `77, .- /F-. ),0156I rr 1 G 5 /vr ,f O <br /> 3 33- ys 5i1Z '//q - /Fs Ah,.4/c f,.t c5 ,3 /, O <br /> Zi cis S'r 7 3'111? % S 05 1 C. S — . 7 /, 6 <br /> .5- 51-sro 7,SLI i2 Vt.- -- / 5 ,1,n sb/c ni 1 - - .7 /. 6 <br /> d, Boring# <br /> 0 Boring 9-5-'a <br /> 7C <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. <br /> *Eff#1 *Eff#2 <br /> 1 6 -y 7x71?3/1. — /5 /mc6/c ,- 1 Ci 36:1- 67 /. 6 <br /> of ct"3F 7,5'/i? `'/y /Fi 4msdfr. ► cr S 1vr .S A c <br /> 3 3g- 5-0 ,5'1i? 9/6 /5 )m s h /c• ,N, 1 5 . 7 /. 4 <br /> 4 .5-a-71 75`1/Z.Py -- /j- )Ms6/r 4 I — - .s'— AG) <br /> *Effluent#1 =BOD,>30<<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) Signat e / CST Number <br /> JA t-s S I./awe/J. s .00....--....4 )734/1 4e9 <br /> Address 17760 —7 75— Dat Ev luation Conducted Telephone Number <br /> W/r c1,5 fr - I4 <br /> o ' ..5-7e?')- C- /6-)0 7/S-866— y/5 7 <br /> SBD-8330(R04/15) <br />