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Wisconsin Department of Safety and Professional Services (__cs ,�T_ Page of <br /> Division of Industry Services Ocv (� <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,but not � `� /� <br /> scale orlmited to:dimens ons,rtical north arrow,andtal reference point location and distancM),ce to direction <br /> road. 07- <br /> slope, Parcel <br /> I.D. 3 _Iy-ID-5"0S-CCE---e!6 oeC+ <br /> Please print all information. evi ed by /1/.4.....4_____ Dat / O2o Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m). ' 17+f3 <br /> Property Owner Property Location 0 0 <br /> Jodi S'-a✓'he Govt.Lot IA ''A S / T 3 J N R /y E (or) W <br /> Property Owner's Mailing Address Lot# Block# Subd.Name or CSM# mc�p# 1,C i 4' <br /> 3 (47 13�,,,ic /2d V. ii r'!al Doc.. ,1441/7 <br /> City State Zip Code Phone Number 0 City 0 Village ©Town Nearest Road <br /> Mk, I ,41n/ I ;503 7 I (614 )7%69 I I RL4.5k ILo F .,,,evi /kW. <br /> 0 New Construction Use:la Residential/Numberof bedrooms_ y -Code derived design flow rate 6(10 GPD <br /> 0 Replacement 0 Public or commercial-Describe: <br /> Parent material E-Lei c I), {7Flood Plan elevation if applicable�`�ft. <br /> General comments and recommendations: s, e 16v c0 , 7 <br /> Boring# <br /> 0 Boring <br /> %E. > <br /> Pit Ground surface elev. ft. Depth to limiting factor <br /> 17 <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. <br /> G' ' g �sy/�3/� — *Eff#1 "Eff#2 <br /> 1 <br /> S //!2 St)/f . pr-i 1 c S 3 i .7 /. E <br /> Y- 36 75`1/7 4/y --- /j ,Iri1;35 /c. ,vi I G- j 3c <br /> 3 36 -C -7,5'7/z`1/j J5 7 /,6 <br /> 5%- yo 7.>'i/Z 37 — S c,i C /11 I — 7 /, E <br /> ,4, Boring# El Boring c 5- 7 > Ze <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. <br /> *Eff#1 *Eff#2 ff#2 <br /> GG 7 /?Yj 1S /117.4/c- /tel CS' _.-5-"Pi /, 6 <br /> 6 - 3 y 7,5yl /y _ <br /> 3 -..3--‘' 7..5-`T/? '/� j_.5 >iii-7s /e l v, 1 l 5- 1 m ,7 /. <br /> L/ 5-6-7) 7,s y,?"7-y -- -5 c'S 6 i',_, / — — . 7 /, <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))',, Signature 1 CST Number <br /> e:w, rs 5 'Jt-z/i/* /S ty� $//� ,1� 7,j`//, e. <br /> Address 7 74 c r/c.y 3' - Date E luation Conducted Telephone Number <br /> 1-1 ''''.1. / -534593 1)- A `-/_ / 9 /s- s>6 /11$ 7 <br /> SBD-8330(R04/15) <br /> f <br />