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Wisconsin Department of Safety and Professional Services C�7��G�, Page of <br /> Division of Industry Services J <br /> SOIL EVALUATION REPORT <br /> In accordance with SPS 385,Wis. Adm. Code County <br /> Attach complete site plan on paper not less than 8 1/2 x 11 inches in size.Plan must include, 13"r n A- <br /> but not limited to:vertical and horizontal reference point(BM),direction and percent slope, Parcel I.D. �4b /b�/�/ ,$ ��' <br /> scale or dimensions,north arrow,and location and distance to nearest road. 07-tyU d nIC <br /> Please print all information. ewedpy Da <br /> tp <br /> Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). � 2 Z <br /> Property Owner 1,� Property Location <br /> i I i�Gi Giti$ Govt.Lot '/4 S l C f T 41e N R E (or) W <br /> Property Owner's Mailing Address Lot� 7 Block# Subd.Name or CSM# <br /> 61Y '73 - Vei4 DjrIVf- 7l' V. I' P115q <br /> Cit(v State Zip Code Phone Number El city [IVillage FA Town Nearest Road <br /> ❑ New Construction Use:[0 Residential/Numberof bedrooms a Code derived design flow rate 30y GPD <br /> El Replacement ❑Public or commercial-Describe: <br /> Parent material �1"r d.1 /]y-i-r* Flood Plan elevation if applicable A1111 ft. <br /> General comments and recommendations: 69 <br /> a Boring# ❑Boring 9),7 <br /> ® 7d Pit Ground surface elev. ft. Depth to limiting factor in. <br /> Soil Application Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/Ft2 <br /> In. Munsell Qu.Az.Cont.Color Gr.Sz.Sh. <br /> 0 $ 7.S yr2 — *Eff#1 *Eff#2 <br /> I S �i»3 6 /� v,, J G 3"h ,7 4 <br /> -2,� 7,5`1R <br /> Boring# ❑Boring �d 7 71f <br /> ®Pit Ground surface elev. ft. Depth to limiting factor in. <br /> Soil Application Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/Fe <br /> In. Munsell Qu.Az.Cont.Color Gr.Sz.Sh. <br /> *EfF#1 *Eff#2 <br /> /A.,-56 is j1, I C S in , 7 Al pq 1 C- s 7 /, 6 <br /> *Effluent#1 =BOD,>305 220 m /L and TSS>30 5150 mg/L *Effluent#2=BOD,>30<_220 mg/L and TSS>30 s 150 mg/L <br /> CST Name(Please Print) Signature CST Number <br /> .�a w, f /o/ S � Qi 7.�Er 04 G <br /> Address )7766 A/-y Date E luation Conducted Telephone Number <br /> we-j,fr`YY r%Vs s93 7- ells`7 <br /> SBD-8330(R04/15) <br />