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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 <br /> Attach complete site plan on paper not less than 8 1/2 x 11 inches in size.Plan must County oil VIM <br /> include,but not limited to:vertical and horizontal reference point(BM),direction and Parcel I.D.07-03od °!/--16--j3-r / <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. O c1 y o 1310 0 <br /> Please print all information. eviewed by Date <br /> Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(l)(m)). <br /> PropertyOwner Property Location <br /> Ric 0/300 Govt.Lot 1/4 1/4 S 13 T y/ N R J6 ©r)® <br /> Property Owner's Mailing Address Lot# Block# Subd.Name or CSM# <br /> Sols g'O*A Sf Al. l I (/, d S P a o 1 <br /> City State Zip Code Phone Number []City. []Village [ETown Nearest Road <br /> .St'vivA.-ler VMAI SSS-O$d I ( ) I .Scars j4-1 /7.11, <br /> E] New Construction Useg) Residential/Number of bedrooms 3 Code derived design flow rate yS0 GPD <br /> ri Replacement 13 Public orcommercial-Describe: <br /> Parent material 0"ryfi Flood Plain elevation if applicable <br /> General comments 0 r e s (/ IF-31 6 <br /> and recommendations: <br /> cl 0 <br /> F 71 Boring# Boring <br /> Pit Ground surfaceelev. gb• dd ft. Depth to limiting factor � ''6 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 *Eff#2 <br /> 3� <br /> ~/ <br /> Boring# El Boring® p 0 Pit Ground surface elev. !6, ft. Depth to limiting factor > 711 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. I *Eff#1 *Eff#2 <br /> o - y 7.S41i731 _ /,f Inos6le- rK l cs , 6 <br /> �/- 7 x`>/Z�y — /ff 1 6 le / GS 3Cv . S /, O <br /> •- 6 <br /> Effluent#1 =BODS>30<220 mg/L and TSS>30<150 mg/L Effluent#2=BODS:�30 mg/L and TSS<30 mg/L <br /> CST Name(Please Print) Signature CST Number <br /> av" t-r S vuni</1 S /✓ 734V o <br /> Address Date Evaluation Conducted Telephone Number <br /> ,( 77/v0 f/.... • ..�5 Lv-cbstrr L✓�� S�f8�i3 �—a�c3- 16 <br /> 7/S- SGG- 4/S7 <br /> SBD-8330(R07/13) <br />