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Wisconsin Department of Safety and Professional Services <br /> Division of Industry Services <br /> • SOIL EVALUATION REPORT Page_of_ <br /> in accordance with SPS 363,Wis. Ad.. Code — <br /> Count <br /> Attach complete site plan vertical <br /> paper not less than B 1/2 x 11 inches in size.Plan mull LI P/ff 1, <br /> Include,but not limited to:veRltal and horizontal reference point(BMI,direction and parcel I.D.C Ov / <br /> 9 a <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. 0 p <D poo <br /> 1 • Please print all information. Reviewed by - Date <br /> Personal inmrmeYon you provide mey be used for secondary purposes Frlvac'y Lew,s.15.04 D1(m). 1,1ii PAAMGll `pizOi/H <br /> Pro /Ry e—y/�v n1e1r J Property LOcalloep <br /> C7 ^y �j l ` 5 Govt.Lot Sr.J 1/4$,9' 114 5 i T 34f N R Y-E(or)JW <br /> Property Owner's Mailing Address Lot Block# S.W.-Name or CSM# <br /> /0' �kl' r, . / /3�- <br /> Ciy rr Slate Zlp Code .no Number ity Villa a Town Nearest Road /rSyY <br /> GrnaTSluv�< / SySyO .( 169^ -P2g63 00� ✓er ro <br /> New Construction Use Residential l Number of bedrooms Code derived design flow rate �i n GPD <br /> R71 Replacement Public or mercial-Describe. — <br /> Parenlmalerial /t}C yo/�/ r'f Flood Plain elevation if applicable tt. <br /> General comments � �' e C. ('/)-•� <br /> and recommendations: <br /> 5'YS76-m ET'Gt! tort.oo <br /> ❑ Bodng# [a Bering <br /> I ❑ Pit Grountl sudace ele¢ p9117_ft. Depth to limiting factor in. SoIIA licalion Rate <br /> Horizon I Depth Dominant Color Redox Description Texture Structure Consislence Boundary Roots I GPDIfF <br /> in. Munsell Ou.Sz. Cont.Color G,.Sz.Sh. -Ef#1 1 'E02 <br /> 110- 7 LN" /5 -7 <br /> 7a( 7,3 Y ff S <br /> I <br /> ❑ Boring# ❑ Boring <<�� <br /> pit Ground surface elev. 04x e. Depth to limiting factor in SoilA licalion Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots I 'Ef#2 <br /> in. Munsell Co.Sz. Cont.Color Gr.Be.Sh. 'EMI <br /> a-/g .SYkY GJ /r736e /yvf� s �F /. 5 5 <br /> 3 7,5 (f,�Z ^14" — <br /> I <br /> 'Effluent#1 =BOD,,30<220 mgt and TRS>30<150 mgrL 'EMuenl#2=BOD <3p mg4 and TSS<30 mgIL <br /> CST Name (Please Pml) 1 Sigrlpture CST Number7G91 <br /> Wade RIIf511D1m p.� G_�_`/�� <br /> Atltlrass �Da�leq Evaluation Conducted Telephone Number <br /> PO[3ox 514,Siren,WI 54372 d _�y (715)349-7286 <br /> , 5u—,>vt.uj <br />