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Wisconsin Department of Safety and Professional Services ORIGINAL Page of <br /> Division of Industry Services C�� �- -94/ <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, <br /> but not limited to:vertical and horizontal reference point(BM),direction and percent slope, 9wel I.D. _o=IS-�l43- <br /> scale or dimensions,north arrow,and location and distance to nearest road. a3,t'�-9 1Z /� 01'1000 <br /> Please print all information. Reviewed by DDat <br /> Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). <br /> PropeYowl <br /> ner Property Location ❑ <br /> .V1 9 C v'✓ Govt.Lot Y4 '/4 S / T `// N R 1S E (or) W <br /> Property Owner's Mailing Address l Lot# Block# Subd.Name or CSM# <br /> ll e - l z <br /> �t— <br /> y State Zip Code Phone Number [ICity El Village El Town Nearest Road 59cp <br /> @ New Construction Use:©Residential/Numberofbedrooms 3 Code derived design flow rate ysd GPD �a1C. ��j'•Z2 �j' <br /> ❑ Replacement ❑Public or commercial-Describe: <br /> Parent material C/l 'c. I Dr -{� Flood Plan elevation if applicable N��ft. <br /> General comments and recommendations: <br /> - <br /> P Boring# ❑Boring nj].yE <br /> Q 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/Fe <br /> In. Munsell Qu.Az.Cont.Color Gr.Sz.Sh. *Eff#1 *Eff#2 <br /> ;Ire j h: rM I c s 3 i�' . 7 �L� <br /> .3 , 173-''/'Z e 5 G- <br /> ❑1 g El Boring Boring# ® ]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/Fe <br /> In. Munsell Qu.Az.Cont.Color Gr.Sz.Sh. *Eff#1 _*Eff#2 <br /> J ��y -2 shrZ — /M-ibll I Jam, ) i s 3F 7 16 <br /> y 77ti1Z ti � — 5 O j ( l G 5 3n) /,6 <br /> 17 <br /> *Effluent#1 =SOD,>30<-220 mg/L and TSS>30 s 150 mg/L *Effluent#2=BOD,>305 220 mg/L and TSS>30<-150 mg/L <br /> CST Name(Please Pri Sign re CST Number <br /> t�li��s S l C 6��-e / 73 �� <br /> Address r)7 76-0 y 3 S� D Evaluation Conducted Telephone Number <br /> SBD-8330(R04/15) <br />