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-``NVANJAJ Wisconsin Department of Safety&Professional Services ORIGINAL Page-of- <br /> Division of Industry Services <br /> SOIL EVALUATION REPORT <br /> YIG I "Ilk * In accordance with SPS 385,Wis.Adm.Code County L <br /> Attach complete site plan on paper not less than 8 1/2 x 11 inches in size.Plan must include, �V/N8/ <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. 07-OlZ-Z'�JD-YJ'/3 Jr If-PIT-01 BU <br /> Please print all information. Revi wed by Date <br /> Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). <br /> Property Owner nn G _/ Property Location <br /> th r'e �UVG}N�j Govt.Lot '/, Y. S T N R E(or) W <br /> Property Owner's Mailing Address� Site Address or CSM and Lot#: <br /> mAJAW <br /> City, State,Zip Phone Number ❑ City ❑Villa e ®Town Nearest Road <br /> VJ 4� ( /- ri Atbq ( ) arc r,,,oN ,B,v Ne/'Lk1,2d <br /> r❑New Construction Use: Residential/Numberof bedrooms Z Code derived designflow rate 3� G P D <br /> 3 Replacement ElP�bll' or scp ercial-Describe: Flood Plan elevation if applicable�ft. <br /> 6 l/ <br /> Parent material aGl� <br /> General comments and recommendations: <br /> MBoring /� <br /> Boring# pit Ground surface elev. �f� ft. Depth to limiting factor in./elev. ft. <br /> Soil Application Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/Ft2 <br /> In. Munsell Qu.Az.Cont.Color Gr.Sz.Sh. *Eff#1 *Eff#2 <br /> 14 <br /> Z S-ky 7Sy yip 47 . 7 <br /> ❑Boring <br /> Boring# [ Pit Ground surface elev.46ft. Depth to limiting factor in./elev. ft. <br /> Soil Application Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/Ft2 <br /> In. Munsell Qu.Az.Cont.Color Gr.Sz.Sh. *Eff#1 *Eff#2 <br /> m �YQ 3/Z e Z/* .G <br /> Z 5-111! -7 Q / /7 4 l� 6 <br /> CST Name(Pleto Print) Signature /' CST Number <br /> ti T/la041 / 851�5`�' <br /> Address ` Date Evaluation Conducted Telephone Number <br /> S Ei6'O� <br /> i B/ /w/40k't6�/aGJI.S"Yb� ly d S aL <br /> *Effluent#1 =BOD>30 5 220 mg/L and TSS>30 5150 mg/L *Effluent#2=BOD,5 30 mg/L and TSS<_30 mg/L <br /> SBD-8330(R03/22) <br />