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Wisconsin Department of Safety and Professional Services <br /> Division of Industry Services <br /> SOIL EVALUATION REPORT CST !� -Aage_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 <br /> include,but not limited to:vertical and horizontal reference point(BM),direction and Parcel I.D.O-/-C40' -ya-/ -3-7 <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. oat'00b-0I7&epd <br /> Please print all information. Rev' wed b Date <br /> Personal information you provide maybe used for secondary purposes(Privacy Law,s.15.04(1)(m)). -11-1 <br /> Property Owner Property Location ri M <br /> DG,w n / �r ✓< Govt.Lot 114 1/4 S -?3T -YQ N R /(v E(or)W <br /> Property Owner's Mailing Address Lot# Block# Subd.Name or CSM# <br /> 716 b0 ,1- <br /> City State Zip Code Phone Number City OUllage VITown Nearest Road a2 7 y70 <br /> RoLvttjj tv'r SY004 ( I Oak/and I /?trv"r :?,/ <br /> ri New Construction Useo Residential/Number of bedrooms 3 Code derived design Flow rate GPD <br /> ®Replacement ri Public or commercial-Describe: <br /> Parent material G lacr� 1 yr f r fi Flood Plain elevation if applicable ft. <br /> General comments <br /> and recommendations: I{Y <br /> Boring <br /> Boring# <br /> Pit Ground surface elev. ft. Depth to limiting factor > 79 in. <br /> Sail Application Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM <br /> in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. *Eff41 *Eff#2 <br /> -Y 31d, -- /J %,"3-4 7 /.6 <br /> d� 3a 7S°i?"/y /Fr/, ,4onS6 5 n a5- I. C� <br /> �=7N 7S'kit $'� <br /> ® Boring# Boring <br /> EN Pit Ground surface elev. 9s• 7 ft. Depth to limiting factor > 81 in. <br /> Soil Application Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff <br /> in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. *Eff#1 *Eff#2 <br /> 0-y -75-VR-3/ _ /-f /0,s6/c Im , -7 A 6 <br /> el &0-34 -Z-OW ' l� 4 W.56le 1 4 S 3ca ,,5-- 1!J <br /> 3 -0 SIR "/y �1m s 6/e <br /> Effluent#1 =BOD >30<220 mg/L and TSS>30 a 150 mg/L Effluent#2=BOD <30 mg/L and TSS<30 mg/L <br /> CST Name(Please Print) &gnature CST Number <br /> 6wrEs S17A �G/3 s al7J o <br /> Address Date Evaluation Conducted Telephone Number <br /> a7760 fJ, �s- GU.e6S�r, lei 5�1$`33 7-,141 / 7 7/S- 0/P- Z/kf-7 <br /> SBD-8330(R07/13) <br />