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Wisconsin Department of Safety and Professional Services ORIGINAL Page of <br /> Division of Industry Services C 5T-24--1 <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 1/2 x 11 inches in size.Plan must include, J '"rF^ <br /> but not limited to:vertical and horizontal reference point(BM),direction and percent slope P3�ce�l P 1S-J 7 tE (o <br /> scale or dimensions,north arrow,and location and distance to nearest road. O /` f�—d-�� <br /> 011660 <br /> Please print all information. Reviewed by <br /> Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). � <br /> Property Owner Property Location <br /> Ctuivi m NSIAv Govt.Lot Y, Y,, S 17 T y0 N WWProperty Owner's Mailing Address Lot# Block# Subd NameorCSM# <br /> J-)49 A66C h4- <br /> City State Zip Code Phone Number ❑Ci <br /> ty ❑Village E]Town- Ne3 <br /> New Construction Use:[�Residential/Numberofbedrooms 3 Code derived �1_design flow rate _CGPD "TG1 X 1p r,3y5 <br /> [51 Replacement ❑Public°�commercial—Describe: <br /> Parent material 1 E�G i Flood Plan elevation if applicable ft. <br /> General comments and recommendations: <br /> I Lk 5`f 0 <br /> DO <br /> ElBoring Boring# <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 A-3 <br /> In. Munsell Qu.Az.Cont.Color Gr.Sz.Sh. <br /> f#2.46 <br /> 7S'li� "1/rP lFS ,,t,„s'��� ,�, I C; S G3y-S,� 7 -5V y b) 7 7.J_7j7sire S r�S l�%c ,►, ► <br /> F71Boring# ❑Boring <br /> (�Pit Ground surface elev. 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 /> l ( 7�17 3/ s i��,s5 l� i c's ,n j. 6 <br /> y-3 �7S'`l1?`le, �d , � � v <br /> 3 3c-- y 7,57iz � /S Wit,»sb/C- �-,� ) l S �.cc _7 / 6 <br /> rn ,__S`-- �, G� <br /> *Effluent#1 =BOD,>30 s 220 m /L and TSS>30 s 150 mg/L *Effluent#2=SOD,>30_<220 m /L and TSS>30 s 150 mg/L <br /> CST Name(Please'Frin4Q Sign ure CST Number <br /> Address )7 7 '0 Di4 Evaluation Conducted Telephone Number <br /> SBO-8330(R04/15) <br />