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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 383,Wis. Adm. Code <br /> 1�23 <br /> �w r <br /> Attach complete site plan on paper not less than 8 1/2 x 11 inches in size.Plan must County p ew <br /> include,but not limited to:vertical and horizontal reference point(BM),direction and Parcel I.D.07-O Int_d„ NG <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. <br /> Please print all information. Revi ed b Date <br /> Personal information you provide maybe used for secondary purposes(Privacy Law,s.15.04(1)(m)). <br /> Property Owner Property Location <br /> 9-v9-vb ffi A les ; Govt.Lot 1/4 1/4 S Q($ T c/O N R /,r E(or)W <br /> Property Owner's Mailing Address �gj <br /> Block# Subd.Name or CSM# <br /> J7019 C/ea �,S/� GP. <br /> City State Zip Code Phone Number ®village Town Nearest Road of�,Vy 9 <br /> G14.3�-er I w / jsy,ely (>/-�') gio— lel 1 JaaX--Mn I Gl,dar Ary Rei <br /> 0 New Construction Usea] Residential/Number of bedrooms_� Code derived design flow rate 300 GPD <br /> n Replacement rl Public or <br /> rrfcommercial-Describe: <br /> Parent material 44 1 f/, iter Flood Plain elevation if applicable ,v M ft. <br /> General comments <br /> and recommendations: Sy f ��en t/ C?d <br /> Boring# 11 <br /> Boring <br /> Inpit Ground surface elev. ft. Depth to limiting factor > `l I 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 /> - u 7 S`/,q 36 -- / f 6 7 c s "P . -7 /,6 <br /> -1 -25 w2'151 <br /> 3 . NO f`1174G <br /> N yo-9) 7SyR 3/ <br /> Boring# ® Boring <br /> ® pit Ground surface elev. `?s-S 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/fF <br /> in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. *Eff#1 *Eff#2 <br /> t b- Lf 7XVI?'3� S 6 /l <br /> /t ,.. 1 !rl 3co , 7 /. 6 <br /> 6 <br /> 'Effluent#1 =BOD >30<220 mg/L and TSS>30<150 mg/L Effluent#2=BOD,:5 30 mg/L and TSS<30 mg/L <br /> CST Name(Please Print) Signature CST Number <br /> e s Jr /-)0&Y1 r -e/.f -.< Liar al 7_3 <br /> Address / 11�, �i Date Evaluation Conducted Telephone Number <br /> J 776D !7w i �.s- LV.e� S�Cr W.l 'jr-el v c-7.-T 0 `al - �s 7 X66- Z//s-7 <br /> SBD-8330(807/13) <br />