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Wisconsin Department of Safety and Professional Services <br />Division of Industry Services <br />RX <br />SOIL EVALUATION REPORT ORiGI%'g� <br />g of <br />in accordance with SPS 383, Wis. Adm. Code <br />Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County v n e7' - <br />include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel <br />percent slope, scale or dimensions, north arrow, and location and distance to nearest road. �e . �� `- i / Coo <br />Please print all information.we by Date <br />Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). _ �t / —19, <br />Property Owner Property Location wcoC�10 <br />'i ►^ le �� Lt El <br />r c Govt. Lot 1 /4 1 /4 S L.1 T 3 g N R% E (or) W <br />Property Owner's Mailing Address'�� Lot # Block # Subd. Name or CSM# <br />196k New F%, �w,ph W AC res ?q Cl /9-4" <br />City State Zip Code Phone Number[]City []Village Town Nearest Road <br />me'l-41-13v"ll e 1 N jq& I I ( ) 6. C & Jh I /"C ih e- /?x/ <br />New Construction Use[j Residential / Number of bedrooms <br />® Replacement n Public or commercial - Describe: <br />Parent material G/oc e i a i D,1 {~i <br />General comments <br />and recommendations <br />Code derived design flow rate `f•5 Cj <br />Flood Plain elevation if applicable /'✓ <br />Boring # <br />[_J Boring <br />Pit Ground surface elev. ,� ft. Depth to limitinq factor % k in. <br />GPD <br />ft. <br />Horizon <br />Depth <br />in. <br />Dominant Color <br />Munsell <br />Redox Description <br />Qu. Sz. Cont. Color <br />Texture <br />Structure <br />Gr. Sz. Sh. <br />Consistence <br />Boundary <br />Roots <br />Soil Application Rate <br />GPD/fe <br />*Eff#1 <br />"Eff#2 <br />l <br />v- y <br />7s`tZ�/l <br />L <br />S <br />%Mss is <br />I <br />cs <br />�'wl <br />. 7 <br />1.6 <br />,j <br />�-1 <br />�..r`l�`// 6 <br />1r S <br />�ms'6 /C <br />yv, ► <br />G S <br />See <br />n <br />rl <br />Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 <br />CST Name (Please Print) S, <br />do -W Yf S ah -e%' <br />Address <br />774,ig A -r., 3.�- Gy-c,6syty,- L1l =S'Y89 <br />Depth to limiting factor %& in. <br />Texture Structure Consistence Boundary Roots <br />Gr. Sz. Sh. <br />Effluent #2 = BOD < 30 <br />Date Evaluation Conducted <br />3 Z/-- /9 /F <br />Soil Application Rate <br />GPD/fF <br />Boring # ,ring <br />Pit Ground surface elev. <br />Horizon <br />Depth <br />in. <br />Dominant Color <br />Munsell <br />Redox Description <br />Qu. Sz. Cont. Color <br />l <br />d - Ll <br />y— l6 <br />7,sbi2 y/� <br />-- <br />3 <br />40 y <br />Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 <br />CST Name (Please Print) S, <br />do -W Yf S ah -e%' <br />Address <br />774,ig A -r., 3.�- Gy-c,6syty,- L1l =S'Y89 <br />Depth to limiting factor %& in. <br />Texture Structure Consistence Boundary Roots <br />Gr. Sz. Sh. <br />Effluent #2 = BOD < 30 <br />Date Evaluation Conducted <br />3 Z/-- /9 /F <br />Soil Application Rate <br />GPD/fF <br />'Eff#1 <br />*Eff#2 <br />7 <br />1,6, <br />O <br />c� <br />'L and TSS < 30 mg/L <br />CST Number <br />��3E1�0 <br />Telephone Number <br />s- 733 0 l,A 7 <br />SBD -8330(R07/13) <br />