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Wisconsin Department of Safety and Professional Services Page of <br /> Division of Industry Services g� ,� f _ <br /> SOIL EVALUATION REPORT <br /> In accordance with SPS 385,Wis. Adm. Code County <br /> Attach complete site plan on paper not less than 8 112 x 11 inches in size.Plan must include, 13�r n 1 <br /> but not limited to:vertical and horizontal reference point(BM),direction and percent slope, Parcel I.D. go <br /> y_s ems-_6��yIno <br /> scale or dimensions,north arrow,and location and distance to nearest road. 07-vd,1-J-Please print all information. Reviewed by Personal information you rovide ma be used for seconds pur oses Privac Law,s.15.04(1)(m)).Property Owner Property LocationR& �°r t �(gat q Govt.Lot M-41 +/, +/, S T t/p N R �yProperty Owner's Mailing Address Lot# Block# Subd.Name or CSM# <br /> S 9.Reb-e,fis Rot IICity State Zip Code Phone Number5 ❑City ❑Village Town Nearest Roadoar a°r w� SlSo IS[e Xobeft <br /> ®New Construction Use:❑Residential/Numberofbedrooms Code derived design flow rate /SQ GPD <br /> ❑ Replacement ❑Public or commercial-Describe: <br /> Parent material G'IaCia I D' Flood Plan elevation if applicable ft. <br /> General comments and recommendations: <br /> sys, 0 le V. CM. 0 <br /> Boring# ❑Boring 96-; <br /> ®Pit Ground surface elev. ft. Depth to limiting factor in. <br /> Soil A lication 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 /> /�n -7 16 <br /> 73-LjR 13 rl M sb/C > I G S 3 C o <br /> s / 6 <br /> 13 o�msb lc Gn l G S /.6 <br /> /-1 Sy- 70 75'(R jy S BS6 <br /> F—xl <br /> Boring# ElBoring <br /> ®Pit Ground surface elev.9'S19 ft. Depth to limiting factor in. <br /> Soil A lication Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/Fe <br /> In. Munsell Qu.Az.Cont.Color Gr.Sz.Sh. <br /> *Eff#1 "Eff#2 <br /> k , 7 1, 6 <br /> V / /,6 <br /> 1,5 h,s�k S /+� 7 46 <br /> *Effluent#1 =BOD,>30 s 220 m /L and TSS>30 s 150 mg/L *Effluent#2=BOD,>30 s 220 mg/L and TSS>30's 150 m /L <br /> CST Name(Please Print) Sig ture CST Number <br /> Jaw-es J De4"i-e(s j73y) a <br /> address oI 7�76 0 //w y 35' D e Evaluation Conducted Telephone Number <br /> SBD-8330(R04/15) <br />