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Wisconsin Department of Safety and Professional Services �1! Q Page of <br /> Division of Industry Services <br /> SOIL EVALUATION REPORT <br /> In accordance with SPS 385,Wis. Adm. Code County <br /> Attach complete site plan on paper riot less than 8 1/2 x 11 inches in size.Plan must Include, +! <br /> but not limited to:vertical and horizontal refarence point(BM),direction and percent slope, Partei I.b.07- Wld ^-3 7�-/B-3v1-Yb 4 <br /> scale or dimensions,north arrdw,and location and distance to nearest road. O p0- O.Ajk D o o <br /> Please print all information, I by Date ,L <br /> Personal information you provide may be used for secondary purposes Privac Law,s.15.04 1 m . S � <br /> Property Owner Property Location ❑ <br /> bee+ L e- Car,,h Govt.Lot '/, Y. s 3d G N R E (or) W <br /> Property OWner's Malling Address Lot# Block# Subd.Name or CSM# <br /> .96a 34 -<,t 6 VdaPI-b(9 y <br /> City State Zip Code Phone Number ❑City ❑village ©Town Nearest Road 11390 <br /> WT- Sy 7a Y I ( /? <br /> [�New Construction Use:❑Residential INumberof bedrooms' Code derived design flow rate 3y©GPD <br /> ❑ Replacement ❑Public or commercial-Describe: Ifs is .5 a n d <br /> Pat material �/!e i ( Qr ti�Y Flood Plan elevation If applicable P am, -0 loading <br /> General comments and recommendations: (ateS <br /> cl q.: b J <br /> a Boring# ❑Boring , <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, "Eff#1 *Eff#2 <br /> 0- 6 7s lP lmj ?'m t <br /> (o- /( 7,5`132 )),,sb '3 <br /> lo,I q 3'`//7 y13 s c 1 wi s 61 y G <br /> 4! 4- -3 0 11 4't/.7 C- .ti a 6 It . 3 <br /> •t.Boring# ❑Boring <br /> III����JJJ ®P!t Ground surface elev. A b ft. Depth to litnifing factor in. <br /> Soll'A6plication 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. *Eff#1 *Eff#2 <br /> 3,b 14 c 3,e <br /> m-S /c <br /> )H,4 b /C M v C <br /> *Effluent#1 =BOD,>30 5 220 mg/L and TSS>30 5150 m /L *Effluent#2=BOD,>30 5 220 m IL and TSS>30 5150 m 1L <br /> CST Name(Please Print). Signatu CST Number <br /> Jent"es > D&c,l.e.l , / 73 C7 <br /> Address d 774 "r 3.S` Date Efvaluation Conducted Telephone Number <br /> w-C,b s)Let, w3""5 y�93 - 8 l yis� �''6H- Yts"7 <br /> SBO.8330(R04/15) <br />