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Wisconsin Department of Safety and Professional Services ORIGINAL Page of <br /> Division of Industry Services �—O*-/�b g <br /> SOIL EVALUATION REPORT <br /> 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, <br /> but not limited to:vertical and horizontal reference point(BM),direction and percent slope, Parcel(�_�_ y 1-/c�-3G-3 a,A - 0 cw <br /> scale or dimensions,north arrow,and location and distance to nearest road. o 7-G' _ G/Sow <br /> El <br /> Please print all information. Re 'awed by Date <br /> Personal information you provide may be used for secondary purposes(Privacy Law,s.15,04(1)(m)). 2 <br /> Property Owner Property Location <br /> I r v I') J 0 A h SCE vl Govt.Lot 2 '/, Y< S 3 T %y/ N R f( �E (or) <br /> Property Owner's Mailing Address Lot# Block# Subd.Name or CSM# <br /> `17G S" lftL�or �� t►, 9 V )tiS is 11 <br /> City , State Zip Code Phone Number ❑City ❑Village S.Town' . Nearest Road �y�/� <br /> /nN 55-03 ) si✓!SS A7/tlerval Gir <br /> New Construction Use:®Residential/Numberofbedrooms Code derived design flow rate oC GPD <br /> []Replacement ❑Public or commercial-Describe: f <br /> Parent material It, I /� ti' �� Flood Plan elevation If applicable <br /> General comments and recommendations: <br /> s cIev 94, 3' 4- 93, <br /> 1❑ El Boring Boring# `]S 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 000tsGPDIR� <br /> In, Munsell Qu,Az,Cont.Color Gr.Sz.Sh. <br /> Boring# ❑Boring �G <br /> ®Pit Ground surface elev.. ft, Depth to limiting factor In. <br /> Soil Ap lication 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 `.,*Eff#2 <br /> 1 0 - Ll 7 5-Y/? �//- — s.�/,1, /- r S r•, -7 J. 6 <br /> `A ! S , -7 A 6 <br /> *Effluent#1 =BOD,>30 s 220 mg/L and TSS>30 s 150 mg/L *Effluent#2=BOD,>30-<220 mg/L and TSS>30 s 150 mg/L <br /> CST Name(Please Print Si at CST Number <br /> J No,V�3 1) "J. .-e- lr I - I ) 7J1-l--) CJ <br /> Address <br /> / ate Evaluation Conducted Telephone Number <br /> SBD-8330(R04/15) <br />