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i <br /> Wisconsin Department of Safety and Professional Services' • ' T i - Page ( of 3 <br /> Division of Industry Services , <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, 1�a _ <br /> but not limited to:vertical and horizontal reference point(BM),direction and percent slope, Parcel 1.0. <br /> scale or dimensions,north arrow,and location and distance to nearest road. D')H-ZZ'{ -75/U p <br /> Please print all information. Reviewed by Date <br /> Personal Information you provide may be used for secondary purposes(Privacy Law,s.15.04(1Xmp, I <br /> Property Owner Property Location 9 ® ❑ <br /> T'n b rM R S J b Q43 2..�lL. Govt.Lot ass y.5 L / S zZ• 7 r N R ( ( E (or) W <br /> Property Owner's Mailing Address Lot# t Block# Sebefrfdathe or CSM# <br /> 3 i t5 (-lat,�k5 Have % Tr i _ 13g3 2, <br /> City tate Zip Code Phone Number ❑City ❑Village ®Town Nearest Road!0 4�.3 <br /> t�e1ortsA- I wl I S-3S32. I ( ) I I_Bnst-oi J ctdrzr' An <br /> ❑New Construction Use:❑Residential/Numberof bedrooms Code derived design flow rate GPD <br /> 0 Replacement IN Public or commercial-Describe:fk5-I-av t'curl*/1'6n /ARIA X I.'^ 3 9 <br /> Parent material Flood Plan elevation If applicable AI Y1 ft. <br /> General comments and recommendations: <br /> Boring# ❑Boring q� <br /> Is Pit Ground surface elev. r.',.3 ft. Depth to limiting factor 27 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 /> I O-• 12 1O'(_(l..?-r-2._ — 5;1 , zfsbk lb'u1 r as z5 • ip .8 <br /> '2.. VI-2.1 to`1R"iii — e.1 Zfs bk m-C'r 9 G.1 I f . q •(, <br /> 3 z3-so IO`i,K Shy rn 4 7.sVRwe, C ( i-is vvf c - . 2 , 3 <br /> r..... Boring# El Boring ��// <br /> 'I ]Pll Ground surface elev9T.8 ft. Depth to limiting factor Z1 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 b�i2 _ (01'12. 11- ,_ — ,s i 1 z-F k ty,,-Fr a S if . L _8 <br /> Z tZ I7 (Dye/4 d 2.-Cs 6k yv.':r i.° k'*' , i( . 6, <br /> 3 17-27 1 d;'R Tit/ c• I ,- sbk, �.t; q w kc . 4 • (o <br /> q i7-So Ib�1RSly_wtzd7Ok4% c1 1-Fs U( ►v.�r g•- - , __ , 3 <br /> • <br /> •Effluent#1=BOD,>30 5 220 mglL and TSS>30 5150 'Effluent#2=BOD,>30 s 220 mg/L and TSS>30 5 150 mg/L <br /> CST Name(Please Print) Sign r CST Number <br /> Steven J.'reamer �-• 0, -C--9 227116 <br /> Address le Evaluaf Ion Conducted Telephone Number <br /> N8468 CTH 0-Waterloo,WI 53594 V// I/b 608-837-5297 <br /> ff SBD-8330(R04/15) <br />