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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 i3t.rp? ell <br /> include,but not limited to:vertical and horizontal reference point(BM),direction and Parcel I.D. o� - 05-o S <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. —oos—03f 000 <br /> Please print all information. R fyiewed by Li <br /> Personal Information you provide may be used forsecondary purposes(Privacy Law,s.15.04(1)(m)). S <br /> Property Owner Property Location <br /> JtA YM 4S R GA Govt.Lot S 1/4 1/4 S a T yU N R /6 E(or)W <br /> Property Owner's Mailing Address Lot# Block# Subd. Name or CSM# <br /> City State Zip Code Phone Number ity 17 V llage Town Nearest Road 6S6,d <br /> P,t!+t.-Sor.. /A 1 S/0N7 (7/ )d`ZS= 7/78 D k/a'n AAl L/4 /7G/ <br /> QNew Construction LlseW Residential/Number of bedrooms 3 Code derived design flow rate clso GPD <br /> F]Replacement ❑ Public or commercial-Describe: <br /> Parent material G le. c/e, Flood Plain elevation if applicable Al/r9 ft. <br /> General comments <br /> and recommendations: sy.s. e1-e✓• 93. <br /> I❑ 11 Boring Boring# <br /> QPit Ground surface elev. r//O.S— ft. Depth to limiting factor ) SO 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 /> o-y 7•-r`//z 3/ /15 /m.5Z/c V- I L5 31" —7 16 <br /> y-Id 7.s`Y�Zy/Y — 1 ,5 cj.„s 6A ,,, t 6-s . 7 /. 6 <br /> 7.-5- — S o-SG f GS .+ .., .-7 16 <br /> • -7 /, G <br /> ® Boring# Boring <br /> Pit Ground surface elev. `76* y ft. Depth to limiting factor 7—70' 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 /> 757/7 3�itLS 3, /, 6 <br /> S-/o 757i? //v s sb/� f G S '3 <br /> 3 <o- y,- I N — s os f 6 ,5 -1 . _7 16 <br /> `4 4'1,-7Y 7s y/7 % — s oS G , I — – . 7 /, 6 <br /> *Effluent#1 =BOD >30<220 mg/L and TSS>30<150 mg/L *Effluent#2=BOD <30 mg/L and TSS<30 mg/L <br /> CST Name (Please Print) CST Number <br /> ,Jam Cs V7/-c/5 Sign ureSJ� d-23y� o <br /> Address Y Date Evaluation Conducted Telephone Number <br /> 7-7 6 a f/w • 3S w c 5.5/•e� wy 2�S:F,3 �f-//-ism - '-//s-7 <br /> SBD-8330(R07/13) <br />