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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 .3 <br /> County <br /> Attach complete site plan on paper not less than 8 1/2 x 11 inches in size.Plan must 8&c t-.,e W <br /> include,but not limited to:vertical and horizontal reference point(BM),direction and Parcel I.D.07-C tY-J1-38--/3"-06-5-"OS- <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. An 0 G,(:V <br /> Please print all information. vie d by Date <br /> Personal information you provide may be used for secondary purposes(Privacy Law,S.15.04(1)(m)). a?—r rl <br /> Propert)yOwner Property Location J 1 <br /> >,/,o vt lz R W Govt.Lot Y 114 114 S � T.3 5 N R /,$" ®r)® <br /> Property Owner's Mailing Address Lot# Block# Subd.;Nafor CSM# <br /> City State Zip Code Phone Numberity E]villageown Nearest Road)tf 7/-� <br /> slvc W� <br /> S-'Y 191a I Z Fs Ne 4e Wrna/o;SLi 17d <br /> New Construction Use@ Residential/Number of bedrooms 3 Code derived design flow rate yS 0 GPD <br /> Replacement rl Public or commercial-Describe: <br /> Parent material G�/4t i A/ or r 111�'Y Flood Plain elevation if applicable <br /> General comments <br /> and recommendations: -57,y e v' <br /> Boring# <br /> Boring <br /> ' Pit Ground surface elev. ft. Depth to limiting factor 6 Ct in. <br /> Soil Application Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF <br /> in. Munsell Qu.Sz. Cont Color Gr.Sz.Sh. 1Eff#1 I `Eff#2 <br /> 0- 4 73--1 34 -- /S //"sb/c rn f c 5 3rn 7 46 <br /> 2 `1- GO "Iy — 1,rG5 s b/< ^ 1 G-3 <br /> bc--IC7.s`/R'�� SY/Z s`g IF-5 0--q1 <br /> ® Boring# n Boring <br /> ER pit Ground surface elev. ft. Depth to limiting factor In. <br /> Soil Application Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff <br /> in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 I 'Eff#2 <br /> -u! 7S`7R3/,r 1.5 IMsb/c nll 1rr .-7 /- 6 <br /> �50 '7S-'!/Z y /L'S Am-f 6,k r7 :re . 5 /. 0 <br /> S-0-7 7.sti/7 h' / 'S 6/c 4,; <br /> Effluent#1 =BOD >30<220 mg/L and TSS>30<150 mg/L Effluent#2=BOD,:<30 mg/L and TSS <br /> CST Nametle(Please Print) S /� / /,Signature S CST Number <br /> ./ s /oda ti.:i ) 73 !/j G <br /> Address 61 Date Evaluation Conducted Telephone Number <br /> 77&0 3S W-r-to -e r- t'vr 5- 9,3 'l ` a (''-l1/ /j-- 5,IL, —/7/5- `7 <br /> SBD-8330(R07/13) <br />