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Wisconsin Department of Safety and Professional Services ORIGINA Page of <br /> Division of Industry Services CIS 1 04„ <br /> SOIL EVALUATION REPORT <br /> In accordance with SPS 385,Wis. Adm. Code County <br /> Attach complete site plan on paper not less than 8 112 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 _y/-lS-� -S IS- LJ7 <br /> scale or dimensions,north arrow,and location and distance to nearest road. 0 7-o �'� _bs Cb0 <br /> Please print all information. Re *ewe, by Date <br /> Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). W 3 2 <br /> Property Owner Property Location <br /> CU 4 v I h d V Govt.Lot 1/4 V4 S -7 T �/! N R /S ❑E (or) �W <br /> Property Owner's Mailing Address Lot# Block# Subd.Name or CSM# <br /> 300,t 41It-de,h D,-,v e o.At let 3 <br /> Cit State Zip Code Phone Number ❑City ❑Village �Town Nearest Road 300,T t <br /> ��t�tS'VVts5 <br /> ©New Construction Use:®Residential/Numberofbedrooms vl Code derived design flow rate GPD <br /> ❑Replacement ❑Public or commercial-Describe: / <br /> Parent material Flood Plan elevation if applicable�l�ft. <br /> General comments and recommendations: <br /> �L, �D ZZ-i <br /> Boring# ❑Boring c� p 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/Ft2 <br /> In, Munsell Qu,Az.Cont.Color Gr.Sz.Sh. . <br /> C - / *EfF#1 *Eff#2. - <br /> r s �,s.6 ;� ► S 3,� , -7 1,6 <br /> nl - 3© c?SG ,M i G s 3ci <br /> 3 0- 5Yc <br /> BoringEl Boring <br /> # Pit Ground surface elev. s eft. Depth to limiting factor >y in. <br /> Soil Application Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/Ft' <br /> In. Munsell Qu.Az.Cont,Color Gr.Sz.Sh. <br /> _`Eff#2 <br /> 6- Lr ,S`ir? '/ S /i,-, sS/'/ 1 -7 <br /> y- 3 '1 L//'/l 0 S G l <br /> w, l G s ��o . � /. 6 <br /> 3T- by 75`liz -/y — S SSG i,, <br /> 14 <br /> *Effluent#1 =BOD,>305 220 mg/L and TSS>30 s 150 mg/L *Effluent#2=BOD,>30 5 220 mg/L and TSS>30-5 150 mg/L <br /> CST Number <br /> CST Name(Please Print) Sig ature ,( <br /> ( ls' / o�./J 7? �f G) <br /> Address )776e, D�to Evaluation Conducted Telephone Number . <br /> /'l/ .7 S- 1- y 1 -7/j-- 5'G - ��/S-7 :: <br /> SBD-8330(R04/15) <br />