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Wisconsin Department of Safety and Professional Services <br /> Division of Industry Services <br /> SOIL EVALUATION REPQRRT r_ Page of <br /> in accordance with SPS 383,Wis. Adm. Code (( J <br /> l�k r n per/ <br /> Attach complete site plan on paper not less than 8 1/2 x 11 inches in size.Plan must County <br /> include,but not limited to:vertical and horizontal reference point(BM),direction and Parcel I.D. <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. <br /> Please print all information. R ' wed `` pato <br /> Personal information you provide may he used for secondary purposes(Privacy Law,s.15.04(1)(m)). <br /> Property Owner Property Location <br /> Ha ro/d U er Govt.Lot 1/4 1/4 S 7 T ya N R /6 E(or)W <br /> Property Owner's Mailing Address Lot# Block# Subd.Name or CSM# <br /> d 6)e Pw 4v c A/ <br /> City State Zip Code Phone Number ity E]Village Town Nearest Road d 9013 <br /> Ro66rns-4le /n a/ 1 S.s91a 1 (7&9 )3s1- fatir Qctk/Rti <br /> rX <br /> New Construction Llse[B Residential/Number of bedrooms 3 Code derived design flow rate y579 GPD <br /> rl Replacement ❑ Public or commercial-Describe: <br /> Parent material C>/ec re. / /?r+ Flood Plain elevation if applicable A//4 ft. <br /> General comments <br /> and recommendations: Sys• -C/'e V. R3' a <br /> Boring# ❑ Boring <br /> ®y Pit Ground surface elev. 6.3 ft. Depth to limiting factor > 76 in. <br /> Soil Application Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff <br /> in. Munsell Ou.Sz. Cont.Color Gr.Sz.Sh. I `Eff#1 `Eff#2 <br /> 0- <br /> ,-,1 7 5`11Z 31 1.5- /,n J4/c # - / C-5 1 3--, . 7 /, fi <br /> `YL y8 7S`//z /{'s a?r X6AC k� 1 G s 3co , -S- /.O <br /> yg- So 7.syi'r%4 — rt o56 , r — d � <br /> ❑a Boring# ❑ Boring <br /> Pq Pit Ground surface elev. 9 G. e, ft. Depth to limiting factor 7 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 /> o. y '.s-9`i2a/ /s /.,s6/c , , I <s a,., . 7 /.6 <br /> J - so 7-5-IR y/y — 7{s sir ab K / G S 3co . -5-- /10 <br /> 3 0 . 71 7.se7,R <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) Signature CST Number <br /> J DAn,{lss7-fW6 <br /> Address Date Evaluation Conducted Telephone Number <br /> 17-74 O I-V fb0 W7- S-9e'?.3 /d - y-/.5`- -7 %6.0-41157 <br /> SBD-8330(RD7/13) <br />