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Wisconsin Department of Safety and Professional Services �� Page of <br /> Division of Industry Services L/ rJ l .—� -/56 <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, ;`� t L }0 <br /> but not limited to:vertical and horizontal reference point(BM),direction and percent slope, Parcel I.D. b 0—/& 3�y3 �7�—dD j Cj 70 G <br /> scale or dimensions,north arrow,and location and distance to nearest road. Q�_0)�` — <br /> Please print all information. ie ad Date <br /> Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04 1 m)). <br /> Property Owner Property Location <br /> �/G Govt.Lot Y, EJ <br /> 14 S T C,, N R ��, E (or) W <br /> Property Owner's Mailing Address Lot# Block# Subd.Name or CSM# <br /> lG! 03� Cor�zis�'f� St .vim3 U. 3 �G'I <br /> City State Zip Code Phone Number ❑City ❑Village ®.Town Nearest Road 7 / <br /> >zl� G11 Ind <br /> (�New Construction Use: Residential/Numberofbedrooms�_Code derived design flow rate V0 GPD <br /> ❑Replacement ❑Public or commercial—Describe: <br /> Parent material /�i ic./ /�:~i N//ft <br /> Flood Plan elevation[f applicable <br /> General comments and recommendations: <br /> a Boring# ❑Boring <br /> [�]Pit Ground surface elev.9 Depth to limiting factor> 7�, <br /> Soil A plication Rate <br /> Horizon Depth Dominant Color Redo�c Description Texture Structure : Consistence Boundary Roots GPD/Ft2 <br /> In. Munsell Qu.Az.Cont.Color Gr.Sz.Sh. <br /> *Eff#1 *Eff#2 <br /> 1 k <br /> /L <br /> a Boring# ❑Baring <br /> [�Pit Ground surface elev. eft. Depth to limiting factor 7 in. <br /> Soil Ap ficatfon 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 /> *E�'— 71j y/� 3 �_ ff#1 '.-_.*Efi#2 <br /> /S S iL Ivl / CS <br /> 7 <br /> �,S2/ <br /> �l -5--V--2)- 757/2 H , l 7 1- 6- <br /> Effluent#1 =BOD,>30 s 220 m /L and TSS>30 s 150 m /L *Effluent#2=BOD,>30 5 220 mg/L and TSS>30"s 150 m /L <br /> CST Name(Please Print Sig ture CST Number <br /> 6,06) <br /> Address ) �-7&0 to Evaluation Conducted Telerhone Number <br /> I-V-e-la - 41- 3 7,tS-FYYII y/5-7 <br /> SBD-8330(R04/15) <br />