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Wisconsin Department of Safety and Poor e..brntl Services ORIGINAL <br /> Division of Industry Services <br /> SOIL EVALUATION REPORT Page_ol_ <br /> I 'in accordance with SPS 383,Wis. Adm. Code � ' q-11 (a �y <br /> county �e7/ <br /> Attach complete site plan on paper not less than 8 fer x 11 inches in size.Plan must <br /> percent but not limited to:vertical and horizontalarrow.reference point(510),direction and parcel LD.0—/ <br /> percent slope,scale or dimensions,north arrow.and location and distance to nearest road. of 00 0/ coo <br /> I Please print all information. Reviewed by Date <br /> Peraonalbrrormauon yeupromoen,avoe useetw secondary perozoes(Pmary law.s.ts.oa prime. L' AL G 'owR/',L/ I <br /> Property Owner y.q Property Location u <br /> / x Govt Loi 114 114 S T $/n N RIS/ E-((or}W- <br /> Propeny ner's ailing Atltlress 'Lot# Block# $x d.Name or CSM# <br /> MW rV i — — <br /> b Groaz State <br /> 11 Lp Code Phone Number []City Village tffTown Nearest Roa/Jd/7 S7 <br /> G Q N 5'D ( I SL � c30Ic/ S <br /> New ConstructionUseResidentialI Number of bedrooms Code convert design flow rate RD C3 GPD <br /> Replacement /J Publico/r cDoercial-Describe: <br /> Parent material t Z'//4-G rFF1 rI Road Plain elevation if applicable ft. <br /> General comments <br /> and recommendations: Pry//, e�av, 96.0 <br /> -01Boring 7 <br /> Boring# 11' r I P <br /> F-71 `` //// <br /> ri Pit Grountl surface elev.��h. DepN to limitirg factor�in. <br /> Soil A Application Rata <br /> Horizon Depth Dominant Color Redox,Description Texture Structure Consistence Boundary Rocts GPDIf? <br /> in. Munsell Ou.Sz. Cont.cow G!.Sz.Sh. -Eft#1 I 'ER#2 <br /> q Boling q <br /> Boring <br /> OC m pit Ground suRace elev. 97,y tt. Depth to limiting tactor in. Spit IiCelion Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPpIb <br /> in. Munsell Du.Sz Cont.Color Or Sz.Sh. 'EfF#1 'Eff#2 <br /> / 0--5- 7 <br /> I <br /> Eluent#1 =SOD, ,30-220 ni and TSS>30<150 mg/l. 'Effluent#2=BOD, 30 mi and TSS<30 mgfL <br /> CST Name (Please Pri ; SignaN e/ CST Number <br /> Wade Rufsholm �'a�"�a1 227(+91 <br /> Address Dale Evaluatbn Canducletl Telephone Number <br /> PO Box 514, Short, W1 54872 (715)349-7286 <br /> oe...� �P• , r <br /> Ir <br />