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Wisconsin Department of Safety and Professional Services Page of <br /> Division of Industry Services �� 2 2 -21 <br /> SOIL EVALUATION REPORT <br /> In accordance with SPS 385,Wis. Adm. Code County L? <br /> Attach complete site plan on paper not less than 8 112 x 11 inches in size.Plan must include, <br /> �:t i•�t�'7Y"" <br /> but not limited to:vertical and horizontal reference point(BM),direction and percent slope, Parcel D. <br /> scale or dimensions,north arrow,and location and distance to nearest road. <br /> Please print all information, anie d by Date <br /> Personal information you provide maybe used for secondary purposes(Privacy Law,s.15.04(1)(m)). ?(� <br /> Property Owner _ Property Location El <br /> ljle-tltle— 1-rah4.rovwe I Govt.Lot 1 '/. Y< S 33 T iIC N R E (or) W <br /> Property Owner's Mailing Address Lot# Block# Subd.Name or CSM� ] y <br /> S-�tl� Sr i►/ 2 � IQ/, <br /> //G y7 S <br /> City State Zip Code Phone Number ❑City ❑Village Town Nearest Road 7/4-) <br /> New Construction Use: Residential/Numberofbedrooms Code derived design flow rate GCt-GPD <br /> ❑ Replacement ❑Public Qr com ercial—Describe: <br /> Parent material C/G L/ A- / Y I � Flood Plan elevation If applicable <br /> General comments and recommendations: <br /> s S' r <br /> © Boring# ❑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/Fe <br /> In. Munsell Qu.Az.Cont.Color Gr.Sz.$h. EEff#1 *Eff#2 <br /> v G 7 S-W? /� S ,r► yf / c S 3F , -7 4 <br /> G- c 7.swz /5 6, <br /> ® g ❑Boring Borin # Of pit Ground surface elev, g� ft. Depth to limiting factor f�b in. <br /> Soil Application Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/Ftz <br /> In. Munsell Qu.Az.Cont.Color Gr.Sz.Sh. <br /> ��-El _*Eff#2 <br /> o- 7 7SN/� 3�/ S /w�} !j�! /� 1 LS 3r' 7 <br /> "- S I 7.S"►rZ v C 1 11 4 /C' O <br /> Effluent#1 =BOD,>30 5 220 m /L and TSS>30 5150 m /L `Effluent#2=BOD,>30 5 220 mg/L and TSS>30 5150 m /L <br /> CST Name(Please Print) Signatur CST Number <br /> ,„ -,S �r uw, S d 7.?e-/j O <br /> Address J776 0 1`�''~-Y S Date E61,,tion Conducted Telephone Numbe <br /> SBD-8330(R04/15) <br />