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, <br /> Wisconsin Department of Safety and Professional Services Page of <br /> Division of Industry Services <br /> SOIL EVALUATION REPORT <br /> In accordance with SPS 385,Wis. Adm. Code County ,L <br /> �arN�IT <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, Parcel I.D.0 7 b i t- -4`0-j-!�- <br /> scale or dimensions,north arrow,and location and distance to nearest road. 097 - o/3 00C <br /> Please print all information. Reviewed by Date <br /> Personal information you provide may be used for secondary purposes Privac Law,s.15.04(1)m). <br /> Property Owner Property Location ❑ Da <br /> Govt.Lot '/4 '/ S T ® N R E (or) W <br /> Property Owner's Mailing Address Lot#3 Block# Subd.Name or CSM# <br /> l j'7 70 y 71,, Ci,cl,e A/�_ <br /> City State Zip Code Phone Number ❑cit <br /> y El Village 21 Town Nearest Road <br /> S 7 l dl t c 6 /Y1 I✓ 537 j4kC K,5 I?CIP G' <br /> IDc New Construction Use:®Residential/Number of bedrooms 3 Code derived design flow rate`fsGGPD <br /> ❑ Replacement ❑Public or commercial-Describe: <br /> Parent material !�/ti[-it/ I?,,i`fr4- Flood Plan elevation if applicable Nl*ft. <br /> General comments and recommendations: <br /> Sys �l�v 93:o 99<el <br /> Boring# ❑Boring 9 c,�, 7 > 7X <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/Ftz <br /> In. Munsell Qu.Az.Cont.Color Gr.Sz.Sh. *Eff#1 *EfF#2 <br /> is 3 m 7 1, 6 <br /> °-/ - ':S` `7-."7 Z`'%y /-s M Sy /C /M I G S 3 e o 7 /i 6 <br /> 3 i/3 7 -7; <br /> 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/Ftz <br /> In. Munsell Qu.Az.Cont.Color Gr.Sz.Sh. *Eff#1 *Eff#2 <br /> 11 23-%1i? 3 J /S /�.,s 5 is ya I c s 3�++ 7 /, 6 <br /> ti 3 7, �-ti�2 `'/�/ / S s 6 /c ,M l S 3 a '7 / 6 <br /> 336 <br /> L/ 3-9- 7 -7,J i2 <br /> *Effluent#1 =BOD,>30 15 220 m /L and TSS>30 15 150 mg/L *Effluent#2=BOD,>30 5 220 mg/L and TSS>30 5 150 m /L <br /> CST Name(Please Print) Sig at ure S ` t�-� CST Number � <br /> Je.M,r �Cl - /-Z/f J �) 73 4i,j <br /> Address , 7?6 C //—y to Evaluation Conducted Telephone Number <br /> tv'e h.s k,r.- Lv.-7-- 5^5'8,17 3 _ zj % c1 -7/S- .VG 6 - L1 iS-7 <br /> SBD-8330(R04/15) <br /> ORIGINAL. <br />