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Wisconsin Department of Safety and Professional Services <br /> Division of Industry Services <br /> SOIL EVALUATION REPORT �// Page of <br /> in accordancevnlh SPS 383.Ws. Adm. Code T-14- <br /> Attach <br /> Attach complete site plan an paper not less than 81/2 x 11 inches M size.Plan must <br /> percentclude,but etlimited to:venical and ions,nhth inroalreferencemnt(distance <br /> to <br /> parcel l,D.��- O1-J- YO-/S-/3- <br /> percentslope.sea leordimensions,north snow.and location and tllstancp to nearest roatl. o•!-_ ve/- o/gveD <br /> Please Print all information. Reviewed by Date <br /> Personal imormationyo.pmWde may be need for secondary purei(Paie,la,S.is.a a ryl tmB_ L2A//i <br /> Property Oymer ®/N - 2+'H <br /> _ Property Location <br /> /rt a�a �Gng r n - Goal.Lot f 1/4 1/4 S/� T'4sp' N R/S E❑((or)Progeny Owner's Mailing MtlPAess 'Lot# Block# Sued.Name or CSM# <br /> 3860 G•« Nc, /YJ Y / u V P Z57 <br /> CitySWte Zip Code Phone Number by ❑Village LIJTown - Nearest Road lLL.fe <br /> ❑ New Construction tlse❑X Residential/Number of bedrooms 3 Code dewed design Bow rate -fe-y GPD <br /> ®ReplacementPubl"ic�ormmmercial-Describe, <br /> Parentmatedal 4 /.42 a/rrfY Flood Plain elevation if applicable /y/f1 itGeneral comments <br /> and recommendations. JyJ e I P✓ - 4d - 7 <br /> Boring# ❑ Bodng <br /> ® Pit Groundsudaceelev, SS' -7 ft. Depth to limiting factor 7 7e in. <br /> Solt A kation Rate <br /> Horizon Depth Dominant Colp Redox Descdpdion TexWre Structure Consistence Boundary Roots GPDI(f <br /> in. Munsell On.Sz. Con,Color G,Sz.Sh. 'E(0!1 'ER112 <br /> a.. / C J 3/n • '7 /G <br /> 3 co .3- /• a <br /> 3 9-7G 7.1-Y O 7c — F,s osa�— <br /> tM J <br /> Bodng# ® Boring <br /> ❑ Pit Ground xidec"lev. `1 y. Y ft, Depth to limiting factor 7 6 in. Sod rcatlon Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff <br /> in. Munsell On.Sz. Cont.Calor Gr.Sz.St. •041 'EffN2 <br /> . 7 / 6 <br /> n, <br /> 'Slipped#1 =BOD,130<220 mg/T and TSS>30<150 mg/L 'Effluent#2=BOD,<30 mgg-and TSS 30 pal <br /> CST Name (Please Pont) Si cure <br /> a a.n 1 J . /)w - r .,/j g sJ CST Number <br /> 7.�ya(O <br /> Address Date Evaluation Conducted Telephone Number <br /> J��6o L 3/' /nY�br/r /✓�SNbS7 7- /S iy 7iS- 566 - 7 <br /> SIMM330(ItWn3) <br />