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Wisconsin Department of Safety and Professional Services ORIG I NAL <br /> Page of /0 <br /> Division of Industry Services C � �3� <br /> SOIL EVALUATION REPORT <br /> In accordance with SPS 385,Wis. Adm. Code County <br /> 13�rn<f� <br /> Attach complete site plan on paper not less than 8 112 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. <br /> scale or dimensions,north arrow,and location and distance to nearest road, <br /> Please print all Information. Reviewed by D <br /> I 3aCtd 2�(Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). <br /> Property Owner _ Property Location 21 <br /> /ewe 0 r J41e)4 S017 r 1 t"e A/I. Govt.Lot '% '% S T y0 N R IS'" E (or) W <br /> Property Owner's Mailing Address Lot# Block# Subd.Name or CSM# <br /> City State Zip Code Phone Number El city ❑Village ®Town Nearest Road <br /> W-e6sitr 14/17 5��9,3 ) Jackson Cc Rd ,q <br /> New Construction Use:❑Residential/Numberof bedrooms Code derived_design flow rate -56GPD `('aX.k b: 3 3Q 22 <br /> ❑Replacement Public or commercial—Describe: Fr <br /> Parent material Flood Plan elevation if applicable NII19ft. <br /> General comments and recommendations: <br /> " SyJ. e 11 v, 9/.p <br /> ❑BoringFT Boring# ul. 7 <br /> m Pit Ground surface elev. ff. 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 Cu.Az.Cont.Color Gr.Sz.Sh. *E01 *042 <br /> 7.5�//?s � S CSG- <br /> — � 7 <br /> Boring# ❑Boring c/y,/ 7� <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*e <br /> In. Munsell Qu.Az.Cont.Color Gr.Sz.Sh. *Eff#1 ',v'Eff#2 <br /> U - y 7,5Lii? / S r,S6/e >M I C"5 3,, 7 46 <br /> J 9- 3) 7S`/1-? y/� %�� C-5 l ';,'j I 6-s "-?Ge . 7 ), 6 <br /> 3 3 — 5-1 7-5-//7 <br /> *Effluent#1 =BOD,>30 5 220 mg/L and TSS>30 5150 mg/L *Effluent#2=BOD,>30<_220 m /L and TSS>30-5 150 m /L <br /> CST Name(PleaseCPrint) � Sign e � ✓���� CST�3 e /L <br /> , 4N-e -5 C 11 1-e S O � <br /> Address ,,177G 0 -7 s' Date valuation Conducted Telephone Number <br /> SBD-8330(R04/15) <br />