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Wisconsin Department of Safety and Professional Services Page <br /> Division of Industry Services (tea-r-i ?-lo-3 of <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.0 7 00-.2-110-/S /3-S'�/.s <br /> scale or dimensions,north arrow,and location and distance to nearest road. o i -- p yoo vp <br /> Please print all information. v e&b Date <br /> Personal information you provide may be used for secondary purposes Privacy Law,s.15.04 1 m . 1 d ,20R <br /> Property Owner _ Property Location ❑ <br /> PC,.f'l f G l c r�' Govt.Lot 1/4 1/4S g I3 T 0 N R t'•S s E (or) W <br /> Property Owner's Mailing Address Lot# Block# Subd.Name or CSM# <br /> Pe' Oe A 337 <br /> City State Zip Code Phone Number <br /> k ❑city ❑Village 0 Town Nearest Road 3 77`� <br /> IZ S G';f hlV .ja 0 b�l -?/J ) 20'e 13e,-, Tf« <br /> New Construction Use:©Residential/Numberof bedrooms_ I Code derived design flow rate 3 f0 GPD <br /> ❑ Replacement ❑Public or commercial-Describe: <br /> Parent material - l c[i a ( i9i-� Flood Plan elevation if applfcableN/'� ft. <br /> General comments and recommendations: 9 q <br /> Boring# ❑Boring G 1 <br /> Pit Ground surface elev. / ft. Depth to limiting factor> 7 Y. <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 /> *Eff91 *Eff#2 <br /> 1 u 7,S wr7 3/3 s /r+�s'L /� rY, 1 C S 3 r✓' -7 / b <br /> Ss= 7ii 7,jyizf%H — is <br /> ® Boring# ❑Boring `( ' <br /> ®Pit Ground surface elev. ft. Depth to limiting factor 7 If-in. <br /> SoilApplication 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. <br /> *Eff#1 *Eff#2 <br /> lmsGi( V" 1 Gs' 3m --7 1, 6 <br /> `I- �G' 7.rLlIZ y 13 �►„s i, is rv, i S 3co /, 6 <br /> *Effluent#1 =BOD,>30 s 220 m /L and TSS>30 s 150 mg/L *Effluent#2=BOD,>30<220 mg/L and TSS>305 150 m /L <br /> CST Name(Please Pri t) Sign ture CST Number <br /> Address 7 7 6 0 ✓ ,-Y 33' D e Evaluation Conducted _ <br /> W rSs t e (�/�� .l� e133? Telephone Number <br /> SBD-8330(R04/15) <br />