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Wisconsin Department of Safety and Professional Services <br /> Division of Industry Services <br /> SOIL EVALUATION REPO T,� Page_of_ <br /> in accordance with SPS 383,Wis. Adm. Code ✓ <br /> County YURNETT <br /> Attach complete site plan on paper not less than 81/2 x 11 inches in size.Plan must <br /> include,but not limited to:vertical and horizontal reference point(BM),direction and Parcel D O 7 O/ 3 9' 17 f ,3 <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. m O <br /> Please print all information. Reviewed Date <br /> Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). <br /> Property Ow er C Q Property Location G <br /> Ali T e'j //O—�ro 4o..3k Govt.Lot SC 1/4`j Lc)1/4 S/5�T-37 <br /> N R f E(or W <br /> Property Owner's Mailing Add re s Lot Block# 9bd:'M118 ame or CS <br /> y — �✓r i3 <br /> City State Zip Code Phone Number ity / Vill a own Nearest R ad O <br /> c) SSo3f3 ( ) Gi .;A GIJoi4 <br /> ew Construction Use Residential!Number of bedrooms Code derived design flow rate © GPD <br /> FI Replacement Public pr co l IDec <br /> Parent material G//4- : <br /> / Flood Plain elevation if applicable ft. <br /> General comments <br /> and recommendations: <br /> Bor ng# 9 <br /> L�J � t Boring <br /> Pit surface elev. / z' S ft. Depth to limiting factor 4kll!5— in. <br /> Soil Application Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff <br /> in. Munsell Qu.Sz. Cent Color Gr.Sz.Sh. *Eff#1 *Eff#2 <br /> /,5 6 1J7C/� �S 7 1,6 <br /> 41 76 7,-S c s ,e l sd K <br /> Boring# Boring �'/7 <br /> 91 Pit Ground surface elev. / /i ft. Depth to limiting factor in. <br /> Foi�iAppucation Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff <br /> in. Munsell Cu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 'Eff#2 <br /> / 0-7 715V / l5 lrhsd ,- cs 7 6 <br /> � �y� 17-SYRVIZF ; <br /> *Effluent#1 =BOD >30<220 mg1L and TSS>30<150 mg/L Effluent#2=BOD <30 mg/L and TSS<30 mg/L <br /> CST Name (Please Print) � " � Sig gqature / CST Number <br /> Wade Rufsholm 2/czoC�.- / 227691 <br /> Address Date Evaluation Conducted Telephone Number <br /> PO Box 514,Siren,WI 54872 S- -3-/ 7 (715)349-7286 <br /> SBD-8330(R07/13) <br />