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r_..`..-7 ORIGINAL Wisc'o ISM Wt o ty d Professional Services Page of <br /> I i i-'r/ .ivision of Industry Services 6%T _ 17/ <br /> l l I'' ; , lir; SOIL EVALUATION REPORT <br /> l <br /> In accordance with SPS 385,Wis. Adm. Code County <br /> Li I <br /> Attach co er no less than 8 1/2 x 11 inches in size.Plan must include, <br /> but,nsk tg v tizont I reference point(BM),direction and percent slope, Parcel � G_/y .U off— (�u'O <br /> -SC cation and distance to nearest road. 07v - ._ c>jtd06 <br /> Please print all information, e ew d by <br /> ..� Date <br /> Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). (t�1L 11//3193 <br /> Property Owner Property Location <br /> J;471-?,n C"e✓'laC,l, Govt.Lot Y. % S /� T tf6 N R I�( E (or) W <br /> 0 Et <br /> Property Owner's Mailing Address Lot# Block# Subd.Name or CSM# 1gjG f,� <br /> l 10 N°..t ti 57'i,i^ L t1 /7g3� <br /> City State Zi Code Phone Number <br /> P ❑City ❑Village Town Nearest Road P 15— <br /> S�— �r �,y tolls 11�� I � I ( ) I I �!otf I st'ctier, R <br /> New Construction Use:0 Residential/Numberof bedrooms Code derived design flow rate GPD <br /> ❑ Replacement 0 Public or commercial—Describe: <br /> Parent material U iicc./ I i) t ' Flood Plan elevation If applicable / ft. <br /> General comments and recommendations: <br /> ,P i t'y .l car "i S <br /> I Boring# 0 Boring �, yj <br /> El Ground surface elev. ft. Depth to limiting factor 7 in. <br /> • Soil Application Rate <br /> Horizon Depth Dominant <br /> Munse Colorll Q Redox Description ' Texture StructureSz.Sh.; Consistence Boundary Roots GPD/Ft2 <br /> u.Az. Color Gr. <br /> *Eff#1 *Eff#2 <br /> 9 7c9l '/y /S • / 6 <br /> • 7 /_ E <br /> 7 )Lf vS 7S-y/7 `'/tr S <br /> y 4.5 2 ����? Dili . 7 / <br /> Boring# 0 Boring <br /> ❑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/Ft2 <br /> In. Munsell Qu.Az.Cont.Color Gr.Sz.Sh. *Eff#1 *Eff#2 <br /> *Effluent#1 =BOD,>30 5 220 mg/L and TSS>30 5 150 mg/L *Effluent#2=BOD,>30_<220 mg/L and TSS>30 5 150 mg/L <br /> CST Name(Please Print) Sign re CST Number <br /> , _..5. .0er...-4 <br /> Address ,277 b s �`� j' Da e Evaj.jation Conducted Telephone Number <br /> �" 6s err u'1- Sri`�S �j'� �') S— ,73 7/5_ ,5:-', - T/.S 2 <br /> SBD-8330(R04/15) <br />