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Wisconsin Department of Safety and Professional Services Page of <br /> Division of Industry Services C 5T-23 — <br /> SOIL EVALUATION REPORT <br /> In accordance with SPS 385,Wis. Adm. Code County 11 <br /> Attach complete site plan on paper not less than 8 1/2 x 11 inches in size.Plan must include, ��rh <br /> but not limited to:vertical and horizontal reference point(BM),direction and percent slope, ParcelJ.D. . ,-17,3p S/S-- g.� -(7�t5'OGt) <br /> scale or dimensions,north arrow,and location and distance to nearest road. 07-0 SS <br /> te <br /> Please print all information, ev we by .. Date <br /> Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). - 11/3'0?.3 <br /> Property Owner Property Location ❑ <br /> J t 0'1 L0--1-17 Ad,-, Govt.Lot Y< Y< S 30 T '-/0 N R /7 E (or) W <br /> Property Owner's Mailing Address Lot# Block# Subd.Name or CSM# <br /> 4f"775- 436tty CAA vve ILI <br /> City State Zip Code Phone Number 0 City 0 Village ®Town Nearest Road /0 ,i es- <br /> by e 0 ml 1.Oi w y I M A) 1 37s 1 i 9 I ( ) I 1 (Ante,r` >R e d Pi h,e 7ra c I <br /> g]New Construction Use:J Residential/Numberof bedrooms Code derived design flow rate 1-/S 1GPD <br /> ❑Replacement 0 Public or commercial-Describe: <br /> Parent material <•bacr a f /3 V. (--tFlood Plan elevation if applicable N��ft. <br /> General comments and recommendations: <br /> S)I.S C I f'tl. U <br /> g 0 Boring <br /> / florin G, <br /> # ]Pit Ground surface elev. 6,6? Depth to limiting factor "�in. <br /> • Soil Application Rate <br /> Horizon Depth Dominant Color Redox Description ' Texture Structure ; Consistence Boundary Roots GRD/Ff2 <br /> In. Munsell Qu.Az.Cont.Color Gr.Sz.Sh. *Eff#1 *Eff#2 <br /> I a-u.l 75`17 .7 r s ihniJ/t. t.� j ( 3m /• 6 <br /> `� - �I 7.5-4 t7`1 / m C `vt I G 5 3-c , '7 /, b <br /> Borin # ❑Boring <br /> g ®Pit Ground surface elev.76,0ft. Depth to limiting factor <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 /> / 0- If 7CY 3/1- — /5 /�►,s6/r' CS err, �, <br /> ) ti- ) ,52 ylti /— .),» s�/ h. I G 3 see ."7 / 6 <br /> 41 S'- 71 7S�i�7�v 5 o s G kit) I 6 -5 d r" - 7 / 6 <br /> *Effluent#1 =BOD,>30 s 220 mg/L and TSS>30 5-150 mg/L *Effluent#2=BOD, >30 5 220 mg/L and TSS>30•5 150 mg/L <br /> CST Name(Please Print)- Sign ture CST Number <br /> �c�r1? es S / �i1t-r/s � S��L )73VJ0 <br /> Address A 7 7(od /�µy '-' ite Evaluation Conducted Telephone Number <br /> iv{�S Y� L1 1?/�S? S-3- 7 if- 86 6- G//-.5 <br /> SBD-8330(R04/15) <br />