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epartrnentofSafetyand Professional services / ���/ <br /> -of industry Services <br /> SOIL EVALUATION R PORT Page f of t <br /> In accordance with SPS 383.Ms. Adm. Code County <br /> Attach complete site plan on paper not less than 81/2 x 11 inches in size.Plan must �7 ` " _ <br /> ' Include,but not limited to:vertical and hor zontal reference point(BM),direction and parcel 1 D. 0 7—0 a8 a <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. 0S-001— /3WO <br /> Please print all information. Re ' d by oate <br /> Personal information you provide may be used for secondary purposes(Pn acy Law,s.15.04(1)(m)). 8—'— `_N <br /> Property Owner Property Location 130 <br /> j¢ ?6/kr� CQ y�, u yj GovL Lot Al 114 5r 114 S a �T y0 N R IzI E(or)W <br /> Property Owner's Mailing Address Lot# Block# I Subd.Name or CSMtt <br /> I/4,20 p0ivit 12ce >3b <br /> City State Zip Code Phone Number oCity [3Vllage Town Nearest Road <br /> S l t Rip <br /> ® New Construction Usea Residential/Number of bedrooms Code derived design flow rate GPD <br /> Replacement ® Public or commercial-Describe: Caw��r a un <br /> Parent material e:N et l gL l De � Flood Plain elevation if applicable /L�f•Z ft. <br /> General comments 4.r_/ <br /> and recommendations: y/j. L l EJ ` ^7 <br /> 1b W+t✓ l <br /> Boring# Boring q 7 <br /> Pit Ground surface elev. /� ft Depth to Omit ng factor in <br /> Sol Application Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots PD <br /> In. Munsell Qu.Sz. Cont Color _Gn Sz.Sh. 'Eff#i 'Eff#2 <br /> 1 a-5' 75r`lfR 3/d 1 — /S ,,.,,-41< I 1 - 3M . 7 /,16 <br /> ms 1e m l 65 <br /> Boring# BdrIng <br /> ® Pit Ground surface elev. c?-?,7__ft Depthto limiting factor 7 65' in. <br /> Soil Application Rate <br /> Horizon Depth Dominant Color Redox Description Taxture Structure Consistence Boundary Roots GPDN <br /> In. Munsell Qu.Sm Cont.Color Gr.Sz-Sh. 'Ef#1 I 'E,= <br /> t a_ s 7-3-11? / s l)'P .5 f 45 �-:� 1,6 <br /> a - aI 7.3h/Z � J S Ms6k / C- S 3eo ,S" /. d <br /> 3 1�`l$ 7s �l7`' l s r,s5 Pir, l �✓� hI < 7 1, 6 <br /> EEiuent#11 =80135�30:<220 mg/L and TSS>30<150 mg/L •Ff luent#2=BOD _<30 mg&and TSS<30 mg/L <br /> CST Name(Please Print) Signature CST Niunber <br /> jd� s e siJ� h„E�� s ��o ')73Gi� o <br /> Address Date Evaluation Conducted Telephone Number <br /> SBD-8330(R07/13) <br />