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<br /> Wisconsin Department of Safety and Professional Services Page of
<br /> Division of Industry Services C'$(_20- 1 617
<br /> SOIL EVALUATION REPORT
<br /> In accordance with SPS 385,Wis. Adm. Code County
<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.
<br /> scale or dimensions,north arrow,and location and distance to nearest road. e lot - Li a 35-- C.5 S GC
<br /> Please print all information. Reviewed by i
<br /> / Date
<br /> Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). / /j IL
<br /> Property Owner Property Location 0
<br /> Et
<br /> •./,it /i e s3 e /Ce t IA Govt.Lot S '/4 '/4 S 35—T yO N R /5-- E (or) W
<br /> Property Owner's,Mailing Address_ Lot# Block# Subd.Name or CSM#
<br /> 5'y:,t 15, etrl/' y rive
<br /> City State Zip Code Phone Number 0 City 0 Village ©Town Nearest Road 3 s'o O
<br /> Nat sc I fps I s,KQ r 6 I ( ) I I �J,.�./Lsom. 15 _57,�'r� ,zd
<br /> © New Construction Use:0 Residential/Numberof bedrooms dt Code derived design flow rate 3'' GPD
<br /> 0 Replacement 0 Public or commercial-Describe:
<br /> Parent material Lit(L(c f 0;.I Fe- Flood Plan elevation if applicable /� ft.
<br /> General comments and recommendations:
<br /> 5rss. e/',/. 9a,g 93, J
<br /> Boring# ❑Boring 71/
<br /> ❑Pit Ground surface elev. 9-5-;(1. 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 /> o -ti 2.s70/ — /3 //0s'6 to i., 1 5 3m / 4
<br /> •
<br /> .. k- A° (Ps ,,isbK MEI 36e ,.5- /,
<br /> 3 ke -co 7.s L//Z 46 — S c)s/ ,,.t 1 6- s a•ivi MIN=
<br /> 4-t _Co - .7' 7.>'7/? / _ 5 0,S' C wt 1 / 1- . 7 /. 6
<br /> Boring# ❑Boring �� 7 711
<br /> ® 4�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 /> e y 7,CY/2 3/ — /S j,.,,56 k y,-, 1 G 5- -3 ,,n , 7 /, ;
<br /> I `/-/Sr 7.5- -jr?`1/. -- //S J„, s4/{
<br /> ,rl Gs xcc, , s— /-es _
<br /> 3 /5—3-.4 .3'"icQ yl� .— 5 056- /41 / 6 S 01 : 7 /. e
<br /> `1 , --,i.- 9 7.5$7,5X# ' e%S 6 t.,--, / _ . 7 / C
<br /> *Effluent#1 =BOD,>30 220 mg/L and TSS>30<150 mg/L *Effluent#2=BOD,>30<-220 mg/L and TSS>30 5 150 mg/L
<br /> CST Name(Please Print) ,, Signature CST Number
<br /> .) vn-e_5" S /C/,0-e/5 E2� s /�Cc- 173 j G%
<br /> Address a1 7760,M--I` 3S' Date aluation Conducted Telephone Number
<br /> i/t/ ift-- 1,47- _5-1/, " 3 q- ( 7-J, C %S= ye6r- 61iS7
<br /> SBD-8330(R04/15)
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