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Wisconsin Department of Safety and Professional Services Page of <br /> Division of Industry Services <br /> SOIL EVALUATION REPORT <br /> In accordance with SPS 385,Wis. Adm. Code County g� iT <br /> Attach complete site plan on paper not less than 8 1/2 x 11 inches in size.Plan must include, <br /> but not limited to:vertical and horizontal reference point(BM),direction and percent slope, Parcel I.D. <br /> scale or dimensions,north arrow,and location and distance to nearest road. 07-O24%Z I6• • i '-«a-OZ4rgpo <br /> Please print all information. vi by Date <br /> Personal information you provide may be used for secondary purposes(Privacy Law.s.15.04(11m)). I <br /> Property Owner Property Location <br /> 0 rid <br /> go i`ettfei� Govt Lot % S T 40 N R 4 E (or) W <br /> Property Owner's Mailing Addres Lot# Block# Subd.Name or # <br /> 3Ip+Q 661-Fva't Jt�r2o5 /S' KAref Cixk� <br /> City State Zip Code Phone Number 0 City 0 Village cs Town i Nearest Road <br /> Etyu,r IwIN 155723 I ( ) I I Oe(kieetud I tilYi2K <br /> 0 New Construction Use:(gi Residential/Numberofbedrooms 3 Code derived design flow rate 1/50GPD <br /> Q Replacement V�1`a�il� t 7' <br /> I ❑Public o commercial—Describe: <br /> Parent material 1 V r + Flood Plan elevation if applicable ,�"oft <br /> General comments and recommendations: <br /> / <br /> onrF 4t ernt1ll ©,vl1 <br /> I ( I Boring# Boring p <br /> 0 Pit Ground surface elev. Depth to limiting factor7eb 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. <br /> I 0-14 , 71z , _ I G "Eff#I 1 *Eff#2 <br /> z 11-36 75'Y2yiy — 5 .7 /6 <br /> 3 36-A9 -7 5�M'sly — f /4 <br /> I I - <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 /> tn. Munsell Qu.Az.Cont_Color Gr.Sz_Sh. <br /> 'Eff#1 *Eff#2 <br /> 'Effluent#1 =BOD,>30 s 220 mg/L and TSS>30 S 150 mg/L *Effluent#2=BOD,>30.220 mg/L and TSS>30 5 150 mg/L <br /> CST Name(Piefise Prin Signature CST Number <br /> er <br /> � um ��®q <br /> Address // Date Evaluation Conducted Telephone Number <br /> 668/ *7eAi /o1 �k; ib) 7/6 —M-62o7.— <br /> SBD-8330(R04/15) <br />