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Wisconsin Department of Safety and Professional Services Cs `�O� Page of <br /> Division of Industry Services <br /> SOIL EVALUATION REPORT <br /> In accordance with SPS 385,Wis. Adm. Code County B <br /> Attach complete site plan on paper not less than 8 1/2 x 11 inches in size.Plan must include, Iv f <br /> but not limited to:vertical and horizontal reference point(BM),direction and percent slope, Parcel U1 -S fS-_�5"/_ (H�GD <br /> scale or dimensions,north arrow,and location and distance to nearest road. u , / <br /> Please print all information. Re ' wed Date CD <br /> Personal information you provide may be used for secondary purposes Privacy Law,s.15.04(1)(m)). I 3 2 <br /> Property Owner Property Location 4111 El <br /> - 811,a V--S Govt.Lot '/< '/< S 1 T ye N R �5 by E (or) W <br /> Property Owner's ailing Address Lot# Block# Subd.Name or CSM# <br /> City State Zip Code Phone Number ❑cit <br /> y ty ❑Village ®.Towne.: Nearest Road 31-/y(( <br /> _r►ivey U'v'vV-e #" l /Y1N Lao,, L-11- <br /> []t New Construction Use:[]Residential/Numberofbedrooms o� Code derived design flow rate d'GPD <br /> ❑Replacement ❑Public or commercial-Describe: <br /> Parent material 11—�/cI-4 1. / 01614 Flood Plan elevation if applicable N11-1-ft. <br /> General comments and recommendations: <br /> Boring# ❑Boring q5* �� <br /> (�Pit Ground surface elev. / ft. Depth to limiting factor m. <br /> Soil Application Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure ; Consistence Boundary Roots ..GPD/Ft? <br /> In. Munsell Qu.Az, Conf.Color Gr.Sz.Sh. *Eff#1. *Eff#2 <br /> y- -1), 5-4 1-2 /`1 S. , /� rn I C� ACC /, 4, <br /> _sal 7 S ti,'"A- -7 1 A <br /> y-� 7 Z/?% OS lL - -7 �, 4- <br /> Boring# ®Boring cJS -1 76 <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,Sh. <br /> `Eff#1 [�.`Eff#2 <br /> l a� s fq7 , 7 /�, <br /> - 7l, 1-7,5-V-511, <br /> *Effluent#1 =SOD,>30 5 220 m /L and TSS>30 5150 mg/L *Effluent#2=BOD,>30 5 220 m /L and TSS>30:5 150 mg/L <br /> CST N me(Please Pri t) Si nature n CST Number <br /> Address 77`C `^ � fate Evaluation Conducted Telephone Number _ <br /> SBD-8330(R04115) <br />