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Wisconsin Department of Safety and Professional Services <br /> Division of Industry Services <br /> SOIL EVALUATION REPO R S I Page_of_ <br /> in accordance with SPS 383,Wis. Adm. Code <br /> rn <br /> Attach complete site plan on paper not less than 8 1/2 x 11 inches in size.Plan must County R%t ett' <br /> include,but not limited to:vertical and horizontal reference point(BM),direction and Parcel I.D.*_`'03a-0)-&I <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. —A N 9-01,3600 <br /> Please print all information. Rev}evd by Date <br /> Personal Information you provide maybe used for secondary purposes(Privacy Law,s.15.04(1)(m)). eJ",-AQ—I <br /> Property Owner Property Location a(ui <br /> LtsIlip A,Ace Govt.Lot 1/4 1/4 S ,?S'T L// INR((o E(r))W <br /> Property Owner's Mailing Address Lot# Block# Subd.Name or CSM# <br /> JOC771 6 re, L jL rs e, 3 <br /> City State Zip Code Phone Number OCity []tillage _ITown Nearest Road 7/ <br /> 1���►+bw r w -5-4 8'3.01 (9�i ) �10- 910 �S SwrsS 'CrA*1 b c rr L�.t <br /> nNew Construction Useo Residential/Number of bedrooms_� Code derived design Flow rate 700 GPD <br /> ®Replacement Ej Public or commercial-Describe: <br /> Parent material 61A4/0� I /J r r t`4- Flood Plain elevation if applicable /U/,* ft. <br /> General comments <br /> and recommendations: S/s• e I{✓ <br /> I❑ Boring Boring# Q <br /> Pit Ground surface elev. / 7 O ft. Depth to limiting factor 7 7y in. <br /> Soil Application Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fI` <br /> in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. *Eff#1 *Eft#2 <br /> / y 7s'rR �7- — Or /orfA& ,.. l c S 3n, . 7 /0 6 <br /> /6 -7 3--Yg'Ylt /f J,►n 56 k ,,., I /r 3 ZG . 77 /.6 <br /> a Boring# Boring <br /> Pit Ground surface elev. ft. Depth to limiting factor S6 in. <br /> Soil Aoolication 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 /> J 0- Y -7r7l?s/ — /S . 7 1. 6 <br /> a 9-/y 715-YR `�/Y — I S 7 106 <br /> 3 -so % S -7 4 (o <br /> y o- *6 7.5-Y& y <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) Signa re CST Number <br /> eJ N r'-�(s 7 a aY,I o <br /> Address Date Evaluation Conducted Telephone Number <br /> 7 W-e6.s7er- t+%i S'y89? .5--Ir-I - lefiS7 <br /> SBD-8330(R07/13) <br />