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Wisconsin Department of Safety and Professional Services <br /> Division of Industry Services <br /> SOIL EVALUATION REPORT <br /> Page_of <br /> in accordance with SPS 383,Wis. Adm. Code <br /> Attach complete site plan on paper not less than 8 1/2 x 11 inches in size.Plan must CountyGr rn <br /> include,but not limited to:vertical and horizontal reference point(BM),direction and <br /> percent slope,scale ordimensions,north arrow,and location and distance to nearest road. Parcel I.D.o7—Cgo -.i''►' Or/4�5-oo� <br /> o Co.?a!3 ego <br /> Please print all information. Re ewed by Date <br /> Personal information you provide may be used for secondary purposes(Privacy Law,S.15.04(1)(m)). _ <br /> Property Owner // Property Location <br /> Ali W u l�f7tccc S er Govt.Lot 1/4 114 S /y T 5l0 N R/7 EE((or))W Property Owner's Mailing Address Lot# Block# Subd. Name or CSM# <br /> g'S 9® W, Fuss Ile 12 // <br /> City State Zip Code Phone Number <br /> ity nVillage tY Town Nearest Road Yf-9d <br /> l�iC?1yfe urSSziFfi3 ((otzS)3.t)—y3/ 7 tAnfabj (N. 3wAsG/./Zo% <br /> Q New Construction Usen Residential/Number of bedrooms_ Code derived design Flow rate �''� GPD <br /> Replacement ❑ Public or commercial-Describe: <br /> Parent material cla"A / �.^r /C z Flood Plain elevation if applicable <br /> General comments <br /> and recommendations: Sys' E' Ic vj [ <br /> Boring# Boring <br /> Ej Pit Ground surface elev. �1�ft. Depth to limiting factor go in. <br /> Horizon Depth Dominant Color Redox Descriptionf;re Structure Consistence Boundary Roots Soil A GPD n Rate <br /> fiNf <br /> in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. <br /> 'Eff#1 *Eff#2 <br /> /.,,s6/cc Amsdlc3fo alms�i/C + 7 ). 6 <br /> -2 2, 6 <br /> �--- � 4•%6 ,,,, ( �- f 1. <br /> Boring# Q Boring <br /> Ifli Pit Ground surface elev. 7/0+ 62 ft. Depth to limiting factor 7 7d in. <br /> SoilN <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots <br /> in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. <br /> GS3ca . <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 /> FAd�dress <br /> Please Print) Signatur CST Number <br /> k l9 I,e/Sp�Date Evaluation Conducted Telephone Number <br /> 0l�l -9--?a /7 • 71,4_EGG y/s� <br /> SBD-8330(R07/13) <br />