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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 <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. 07-012-2-40'fi. -iS•S/5-26-ogg000 <br /> Please print all information. Reviewed by Date <br /> Personal information you provide may be used for secondary purposes(Privacy Law,s.15,04(1)(m)), <br /> Property Owner Property Location 0 ❑ <br /> I 'm m 1 a1 Govt.Lot '/ / S T N R E (or) W <br /> Pr pg Owners Mailing Address Lot Block# Subd.Name or CSM# <br /> t 1(0 0 51t-►/Y1 c= , 77 78 Px 1Z1O4E Qnn l 1414 <br /> City State Zip Code Phone Number 0 City 0 Village *Et Town Nearest Road <br /> WO Mal I WI I64( I ( 1$ I ISA-ciao.l I NloriNmil-4nin Dn- <br /> 0 New Construction Usel8 Residential/Numberof bedrooms 7.-Code derived design flow rate ar GPD <br /> % Replacement ❑Public or commercial-Describe: <br /> Parent material e'aLPry . bil.Wr Flood Plan elevation if applicable AO ft. <br /> General comments and recommendations: <br /> gip- Sys- CI- 141 <br /> Boring# ❑Boring Q <br /> 1A Pit Ground surface elev.R6.3 ft. Depth to limiting factor 757 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 /> b-1 7 S lit sIz _ �_ Is 069 KO es � 1 <br /> 7- 7-57 7,54,244 Is OS woo 2.w .1 <br /> Z Boring# ❑Boring <br /> l,Pit Ground surface elev.%(0 ft. Depth to limiting factored 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 /> 1 0-1 '1•59ft3)'i ,---- IS 053 h,,, c 5 2►r‘ .-1 <br /> 2- 1-Co 1,Syt_ilt 1S Os iutl 2m -1 <br /> *Effluent#1 =BOD,>30 5 220 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) Signature CST Number <br /> 74` s ,,,i. 2.25$51 <br /> Address ateEvaluation C nducted Telephone Number, <br /> 60 <br /> 35 V it — - i15- Sbb-4 <br /> �---1 ( SBD-8330(R04/15) <br />