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Wisconsin Department of Safety and Professional Services Page of <br /> Division of Industry Services Cu{ pry+ 1 <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. ��/7_db py� <br /> scale or dimensions,north arrow,and location and distance to nearest road. lot- 3Z"'A <br /> Please print all information. v'ew d by Date <br /> Personal information you provide maybe used for secondary purposes(Prfvacy Law,s.15.04(1)m). !1a11; <br /> Property Owner Property Location ❑ 21 <br /> Tee,-yZ6.P-jpi"I Tor u$'f Govt.Lot '/, V4 S T 410 N R 1-7 E (or) W <br /> Property Owner's Mailing Addrejs Lot# Block# Subd.Name or CSM# <br /> City State Zip Code Phone Number ❑City ❑village ®Town Nearest Road <br /> 6,114-W ktv 13-Y6'73 1 1 k lv- <br /> []New Construction Use:® Residential/Number of bedrooms 3 Code derived design flow rate 'dj29PD <br /> ❑Replacement ❑Public or commercial—Describe: <br /> Parent material_ �/�1C ��' �7 Flood Plan elevation if applicable IV/f1-ft. <br /> General comments and recommendations: <br /> ' ❑Boring $� <br /> Boring# ®pit Ground surface elev. g y ft. Depth to limiting factor in. <br /> Soil Application Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure ; Consistence Boundary Roots GPD/Fe <br /> In. Munsell Qu.Az.Cont.Color Gr.Sz.Sh. *Eff#1. *Eff#2 <br /> J ms k 5- /' D <br /> d,"S6/Z 11 1 s n, <br /> a//-Sy �sylZ y�G s .15� ► G's ,�,ti 7 1,6 <br /> vr• i�-6t Z/' 7.S''I(l yI3 '`^ '�•Fl�' h.cnGa <br /> ❑ g ❑Boring Boren # ❑Pit Ground surface elev.71Y ft. Depth to limiting factor 7 Yiln. <br /> 5oil,4 lication Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/Fe <br /> In. Munsell Qu.Az,Cont.Color Gr.Sz.Sh. *Eff#1 .*Eff#2 <br /> - L 7s�/? 3/ 1S / 61c S m -7 1,6 <br /> `'/ — s5k .n ! 3cc , 7 1, 4 <br /> 3 S-3- 76 7y yR s — s' �5 <br /> *Effluent#1 =BOD,>305 220 m /L and TSS>30 5150 m /L *Effluent#2=BOD,>30 5 220 m /L and TSS>30 5150 m /L <br /> CST Name(Please Print) Signature CST Number <br /> r I-f f - �� /3 /,)6 <br /> Address d 77a' /A17 3 r D Evaluation Conducted Telephone Number <br /> .�b o Ll 7 <br /> SBD-8330(R04/15) <br />