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, <br /> Wisconsin Department of Safety and Professional Services <br /> Division of Industry Services <br /> SOIL EVALUATION REPORT Page_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 (3c.r n •e r`/ <br /> include,but not limited to:vertical and horizontal reference point(BM),direction and Parcel I.D. 0 7' Ord'd *Y-4 -r S- 13- s i S-- <br /> percent <br /> -percent slope,scale or dimensions,north arrow,and location and distance to nearest road. ONS"-4'700 00 <br /> Please print all information. Reviewed by Date <br /> Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). <br /> Property Owner Property Location <br /> To e dd /i I& Govt.Lot 1/4 1/4 S y 1 T y0 N R JS E(or)W <br /> Property Owner's Mailing Address Lot# Block# Subd. Name or CSM# <br /> 3S'7o B-er, 7.-e C.--r 63 <br /> city State Zip Code Phone Number ity ®Vllage Town Nearest Road 3S"70 <br /> Van bar N/_r I SN8 3p ( ) /AG XJbN 43em4- /I-e-- Cell- <br /> New <br /> rpNew Construction Useo Residential/Number of bedrooms�� Code derived design flow rate NSO GPD <br /> nReplacement Q Public or commercial-Describe: <br /> Parent material /.c c r A r<Ve Flood Plain elevation if applicable n!114 ft. <br /> General comments <br /> and recommendations: S/'_S, c/`e✓ O <br /> ❑ Boring# 11 Boring <br /> Ql Pit Ground surface elev, g 6.j ft. Depth to limiting factor_?' 8 7 in. <br /> Soil Application Rate <br /> HorizonEDepthDominantColor Redox Description Texture Structure Consistence Boundary Roots GPD/ff <br /> Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. Eff#1 `Eff#2 <br /> 7.,T/l73/J — /S /MJrS/G �nl CS -7 M 7 <br /> '!- 3 o .XW?"0/•/ — %rs J3C . 5- 44 <br /> ? 30--r 7-r9Q S/L — /f--f S' A e <br /> Boring# ® Boring <br /> ❑X Pit Ground surface elev. `IG• d ft. Depth to limiting factor 7 40 in. Soil Application Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' <br /> in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. `Eff#1 I `Eff#2 <br /> / <br /> 6- %q 7..Sy 12 Jh — /s /,.,sb /c f c s 3.vr _ 7 A6 <br /> •� `'1- It, 7.S`//? `//y - AeS 3Go 5- !, d <br /> -7 6-44 7.SN/z >�L — 9 y� S a n, 5 6/c <br /> Z/ yli- 909 ?•J-1 R sly <br /> Effluent#1 =BOD >30<220 mg/L and TSS>30<150 mg/L Effluent#2=BOD,:5 30 mg/L and TSS<30 mg/L <br /> CST Name (Please Print) Signature CST Number <br /> 1)u 1. ,r s J pi J 3 4010 <br /> Address Date Evaluation Conducted Telephone Number <br /> 3S W%ebt/v✓ wT <br /> SBD-8330(207/13) <br />