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Wisconsin Department of Safety and Professional Services �y Page of <br /> Division of Industry Services L 's <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, <br /> but not limited to:vertical and horizontal reference point(BM),direction and percent slope, oPar el ._ ._/3-S`GS`-4G -O/`/ v <br /> scale or dimensions,north arrow,and location and distance to nearest road. <br /> Please print all information. evi ecLby a{E� nAtQ <br /> Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)m). <br /> Property Owner Property Location ❑ <br /> `r f ti p i! S Govt.Lot 1/41/45 i. T 3 N R %�/ E (or) W <br /> Property Owners Mailing Address Lot# Block#7 Subd.Na e or CSM# <br /> 54 IV �r �tf 1w i?!� a �, 1 � 177 <br /> City State Zip Code Phone Number ❑City ❑Village (Town Nearest Road)L>a <br /> ❑ New Construction Use: Residential/Numberof bedrooms_-'? Code derived design flow rate VO GPD <br /> [� Replacement ❑Public or commercial-Describe: <br /> P/ <br /> Parent material �.r Uet f �7s r�°f Flood Plan elevation if applicable ft. <br /> General comments and recommendations: -�Y-' 'r1.�`! 1 ,to <br /> Boring# ❑Boring g1j.7 7 t I �U <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/Ft2 <br /> In. Munsell Qu.Az.Cont.Color Gr.Sz.Sh. *Eff#1 *Eff#2 <br /> - 7S'�R"�' -- /S /MA le i� 1 G 5 307 -7 1, 6 <br /> 3- -9- r1-( "14 — /S ms-4 x n I G 5 4 i" -7 1, 6 <br /> 3 a 7.s-' �Z �57 <br /> Boring# ®Boring yy.07� <br /> El 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 /> *Eff#1 *Eff#2 <br /> o . 75W?3f /S . 7 / 16 <br /> e 71 7s' 66 <br /> *Effluent#1 =BOD,>30-<220 mg/L and TSS>30<-150 mg/L *Effluent#2=BOD,>30<220 mg/L and TSS>30<_150 mg/L <br /> CST Name(Please Print) Signatu CST Number <br /> Address .4 7 7' -Y 3�s— Date valuation Conducted Telephone Number <br /> SBD-8330(R04/15) <br />