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Wisconsin Department of Safety and Professional Services �,l ORIGINALPage of <br /> Division of Industry Services C V� ..A// <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, Pagel <br /> scale or dimensions,north arrow,and location and distance to nearest road. c�G,0 <br /> Please print all information. Re ewed by D to <br /> Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). <br /> Property Owner Property Location <br /> El <br /> Jo 6« - 11t c; Govt.Lot '/ '/, S 35 T y0 N R j j E (or) W <br /> Property Owner s Mailing Address Lot# Block# Fbd.Name or CSM# <br /> e- 72e�. <br /> City e State Zip Cod Phone Number ❑City' !(c�I f In� �'�//� ty El .Town': Nearest Road <br /> Z I nn dd <br /> f`CICSo✓1 5, 51,6o-e <br /> ®New Construction Use:5j Residential/Numberofbedrooms Code.derived_design flow rate yS�'G P D <br /> ❑Replacement ❑Public or commercial—Describe: <br /> Parent material 6-/14 C.i w l D, f Flood Plan elevation If applicable /�ft. <br /> General comments and recommendations: <br /> F/IBoring# ❑Boring 9 .7 y <br /> [1]Pit Ground surface elev, j. ft. Depth to limiting factor in. <br /> Soil Application Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure ; Consistence Boufry GPD/Ft2 <br /> In. Munsell Qu.Az.Cont.Color Gr.Sz.Sh. <br /> *Eff#1. *Eff#2 <br /> 0- 9. 7,P7/2 31A Is C4-dc' 7S 1R V'fn,Ll -3 t- 711 7­s'lR -71 — s' n S l I . -7 <br /> ❑ Boring <br /> Boring o/ # 9 7 <br /> ❑Pit Ground surface elev. ft. Depth to limiting factor in. <br /> Soil A placation Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/Fe <br /> In. Munsell Qu.Az.Cont.Color Gr.Sz.Sh. *Eff#1 `Efr <br /> 0- y 7,s'nz�/1 — ' 7 / 6 <br /> 7,5-y/?t// S `7 6 <br /> y/ — s -7 /, <br /> *Effluent#1 =BOD,>30 s 220 m /Land TSS>30 5150 mg/L *Effluent#2=BOD,>30 5 220 mg/L and TSS>30"s 150 m /L <br /> CST Name(Please Print) Signat re / CST Number <br /> -e S S D"I<, r e is � f ) 73 z/,)& <br /> Address -7 7 G C` //4-/ S Dat Evaluation Conducted Telephone Number <br /> t,✓�� fry 14✓�27- 53 i- /7- y 7/ 7 <br /> SBD-8330(R04/15) <br />