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WtSconsin Department of Safety and Professional Services <br /> Division of Industry Services <br /> SOIL EVALUATION REPORT Page <br /> in accordance with SPS 383,Wis. Adm. Code T C,/ <br /> Attach complete site plan on paper not less than 8 1/2 x 11 inches in size.Plan must County !-r71AV.„ -C-71t- <br /> include,but not limited to:vertical and horizontal reference point(BM),direction and Parcel I.D.O7”03.4'-1'Y/./16 <br /> percent slope,scale ordimensions,north arrow,and location and distance to nearest road. 04y-Od ODO O <br /> Please print all information. Rev' ed by Date <br /> Personal Information you provide may be used forsecondary purposes(Privacy Law,s.15.04(1)(m)). <br /> PropertyOwnerProperty Location J �Q <br /> /CElr Q✓ Govt.Lot 1/4 1/4 S 4? T G// N R E�(or)® <br /> Property Owner's Mailing Address ' Lot# Block# Subd. Name or CSM# <br /> 1 H r view /e <br /> City 7 State Zip Code Phone Number ity Village YjTown Nearest Road 3093d <br /> lY Va./le I�/✓ .5�.�/� (S,s".1)9 - y8'6 SW/J1 Towe, /fid <br /> New Construction Use>ID Residential/Number of bedrooms LI Code derived design flow rate Od GPD <br /> Replacement Public or c mmercial-Describe: <br /> Parent material l/G C r a / �f r`{x Flood Plain elevation if applicable IyI14 h <br /> General comments S te /r 4�p 4-1 <br /> and recommendations: S/ <br /> laW-ee, S3 . o <br /> ❑ Boring# <br /> Boring <br /> Pit Ground surface elev. ft Depth to limiting factor in. <br /> Soil ADDlication Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/f` <br /> in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 I 'Eff#2 <br /> / !moo- 4 KR �� — ,,, 6/c ,�, / s 3•�, 7 /. 6 <br /> of ! <br /> If 7X'7/7 '/Y /1 wrJS/< / ds 3OG ? A <br /> 71 7.S7,7 �,, — S <br /> ❑ Boring# n Boring <br /> d [Z Pit Ground surface elev. 97 O ft. Depth to limiting factor > 74 in. <br /> Soil Application Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff <br /> in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 I 'Eff#2 <br /> e. 7-5`iA �� — s ^s6le ..•r / C Ir -;%W1 . 7 /. 6 <br /> y /g 7 1,5 )Msb(< 7 /r 6 <br /> 9 7X7Ay4 <br /> ' /- <br /> Effluent#1 =BOD >30<220 mg/L and TSS>30<150 mg/L Effluent#2=BOD,:<30 mg/L and TSS<30 mg/L <br /> CST Name (Please Print) ignature CST Number <br /> Address Date Evaluation Conducted Telephone Number <br /> 776 0 l44h,.41,r. wS <br /> S[3D-8330(1107/13) <br />