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Wisconsin Department of Safety and Professional Services C�t!� -� Page of <br /> Division of Industry Services �Q �t <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, Parcel I.D.©7-da y- '3 -/ /3-S-'el 7 <br /> scale or dimensions,north arrow,and location and distance to nearest road. 4 Oi b 6700 <br /> Please print all information. Reviewed I;Ly Date q <br /> Personal information you provide may be used for secondary purposes Privacy Law,s.15.04 1 m . L'"- " <br /> Property Owner Property Location ❑ ❑ <br /> /0 n v k �G 11 S L'11 Govt.Lot Y< Y4 S 13 T 3 9 N R I q E (or) <br /> Property Owners Mailing Address Lot# Block# T��� <br /> 77 <br /> City State Zip Code Phone Number <br /> �' El city ❑Village 0 Town Nearest Road bd 3 <br /> Sl��c,•e vrew N 3�ti.�">d b �.�� - <br /> ) Lr1, G, se#L/- 1Zd <br /> ❑ New Construction Use:®Residential/Number of bedrooms A Code derived design flow rate 3c,47 GPD <br /> [� Replacement ❑Public or commercial-Describe: <br /> Parent material f g-c 1, r 0. -C fir- Flood Plan elevation if applicable A14 ft. <br /> General comments and recommendations: 5X-5 e lei., 9'9,o/9 3,j/93, 0 <br /> Boring# ❑Boring % 7 '7( <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 /> I - 7,5"717 3/ S /••v+s ble ; �,, 1 L 3m . 7 46 <br /> 4i— `f 7,3'Y it "/`l -- 1S /M sue/IC P-,I 6-5 3 c o : 7 6 <br /> ® Boring# ®Boring �S-E> -2 W <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- -�,.5-7Z 7/,,, — i S' 7 1. el <br /> �► lr, s-i/� y141. ! s � 7 /, 6 <br /> l�-s � s ib v/ s <br /> W 7,S7���i 7 , 6 <br /> *Effluent#1 =SOD,>30 5 220 m /L and TSS>30 5 150 mg/L *Effluent#2=BOD,>30 5 220 mg/L and TSS>30 5 150 m /L <br /> CST Name(Please Print) Signatur CST Number <br /> Address � 77 Date daluation Conducted Telephone Number <br /> E-VO-43ILe <br /> SBD-8330(R04/15) <br /> ORIGINAL <br />