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Wisconsin Department of Safety and Professional Services Page of <br /> Division of Industry Services CT--2 2—C y.— <br /> SOIL EVALUATION REPORT <br /> In accordance with SPS 385,Wis. Adm. Code County Y <br /> Attach complete site plan on paper not less than 8 112 x 11 inches in size.Plan must include, - `` l� r <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. 3475-- <br /> Please print all information. a ie ed by to <br /> Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)m)). <br /> Property Owner Property Location El Ow <br /> K6 Z/'0L k Govt.Lot '% V4 /o T yO N R /S'— E (or) W <br /> Property <br /> 3wn M ailing Address Lot# Block# Subd.Name or CSM# <br /> City State Zip Code Phone Number ❑City ❑Village ©Town Nearest Road A 175' <br /> ®New Construction Use: Residential/Numberofbedrooms Code derived design flow rate q! 49 GPD <br /> ❑ Replacement Public or co mercial—Describe: <br /> Parent material Cr /`t em l �r3r/te7' Flood Plan elevation If applicable ' . <br /> General comments and recommendations: <br /> ❑Boring 7j <br /> F Boring# pit Ground surface elev.C1 3-0ft. Depth to limiting factor J 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 'FEff#2 <br /> l G -S" 75`1i2 / 1S .:fm bk . 1 G 5 3m 7 A <br /> J- 'e 7S2fi2" 6 — s 645( /, G <br /> a Boring# ❑Boring Qft. 7L/ <br /> (�Pit Ground surface elev. � Depth to limiting factor i�i. <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. <br /> o- 1 7-3-y? 3/ r,� .� r 1 6.3 <br /> �• . 7 , !, <br /> 14-J1 75-'7/7� C.S 3cc . 7 / 6 <br /> y 9 7 7.3-tes7 <br /> Effluent#1 =SOD,>30 5 220 m /L and TSS>30 5 150 m /L 'Effluent#2=BOD,>30 5 220 mg/L and TSS>30-s 150 m /L <br /> CST Name(Please Print) Signa re CST Number <br /> J&m l.s - ' d rt 0-7 t{1 .Si� 774/ <br /> Address )7711 //y am Da Evaluation Conducted Telephone Number <br /> SBD-8330(R04/15) <br />