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Wisconsin Department of Safety and Professional Services Page of <br /> Division of Industry Services CCv 0�3 _QL� <br /> SOIL EVALUATION REPORT <br /> In accordance with SPS 385,Wis. Adm. Code County <br /> CA Y✓A-Q <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. 07-c71J,'�-40-15-3S-S OS--Ov,S-p)Xpp0 <br /> Please print all information. eviewed b Date <br /> Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)m <br /> Property Owner JJ Property Location <br /> Jd�'I l 0 E K t le Govt.Lot S '% '% S 3,5-T 410 N R /.S W <br /> Property Owner's Mailing Address Lot f' Block# Subd.Name or CSM# <br /> / kCxriGlc T a V. /S ?) 8 <br /> City State Zip Code Phone Number El city El Village ®Town Nearest Road31 <br /> ? <br /> L,let v;`t-c I AA/ -5:Fayy I I I Je.LlesePi I S, .54el .e <br /> ❑New Construction Use:[a Residential INumberof bed:rooms 3 Code derived design flow rate ysa GPD <br /> Replacement �r ❑Public or commercial-Describe: <br /> Parent material (r/it/u / D'i tit Flood Plan elevation If applicable' ft. <br /> General comments and recommendations 3'y 3. e le w cl j, S�t o cl S. S- <br /> ❑r Boring# El Boring 9� 3 7 7� <br /> 6 ®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/Ff <br /> In. Munsell Qu.Az.Cont.Color Gr.Sz.Sh. *Eff#1 *Eff#2 <br /> ,� S-3 ro �..��-i�? `�/ _ - /S d rv,sb �� ► G s ��o . 7 �, b <br /> 3 3 b -7ti 7 S y/7 H�y FS vn.S b <br /> ❑ Boring# ❑Boring 9.1,.S <br /> ®Pit Ground surface elev. ft. Depth to limiting factor 6 bin. <br /> Soil Application Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/Ftz <br /> In. Munsell Qu.Az.Cont.Color Gr.Sz.Sh. <br /> *Eff#1 _`Eff#2 <br /> / D - 6 ,5y/? 3/ — A, /c C5 3' . -7 /. 6 <br /> 30-5-11 -7,Stii? `A — IFS /c I rr.S 11 iz-7 1 . S /, O <br /> Ll sy-66 71'//? 11 — 1-5 s6/e l — `7 1, 6 <br /> *Effluent#1 =BOD,>30 s 220 m /L and TSS>30 5150 m /L *Effluent#2=BOD,>30-<220 mg/L and TSS>30 s 150 m /L <br /> CST Name(Please Print) Signature CST Number <br /> a , e S S Ocl If I dT" 0 , 13"0 D <br /> Address ,1 7�G 0 -?J­ Date Evaluation Conducted Telephone Number <br /> Lv-ehstz 7 _S- <br /> SBD-8330(R04/15) <br />