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Wisconsin Department of Safety and Professional Services ^ n �D Page of <br /> Division of Industry Services US <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. `'/!J <br /> scale or dimensions,north arrow,and location and distance to nearest road. OU 6 G 1/ U 0 U <br /> Please print all information. iewe by ate <br /> Personal information you provide may be used for seconds purposes(Privac I <br /> Law,s.15.04 1)m). Sate <br /> -✓9 <br /> Property Owner Property Locatpn ❑ El <br /> Pt' -e v Govt.Lot -( '/< % S ,S3 T 410 N R !y E (or) W <br /> +Property Owner'sii Mailing Address 1 Lot# Block# Subd.Name or CSM# <br /> v <br /> City State Zip Code Phone Number city g ®Town Nearest Road )Y-� 5 <br /> L' cl ❑ ty ❑Villa e <br /> New Construction Use:❑Residential/Numberof bedrooms 3 Code derived design flow rate `�s�'GPD <br /> ❑ Replacement ❑Public or commercial-Describe: <br /> Parent material e! f < iC-( Z); 'T�- Flood Plan elevation if applicable /✓/97ft. <br /> General comments and recommendations: <br /> Boring# ❑Boring <br /> 1 Pit Ground surface elev. 91/4. Depth to limiting factor > 7X 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 /> cs L-f '7.5W 7 3/). — !S /1-, 7 J, <br /> °t W -7.5-Li/t l!- 4 m <br /> ® Boring# ❑Boring <br /> Pit Ground surface.elev.�` 9 ft. Depth to limiting factor '7-X='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. <br /> *Eff#1 *Eff#2 <br /> `1 76-1i7�` <b& cam, I C 5 3m . 7 l <br /> Zf- 7.5'Ll 1?'Xit 6le 6: 5 3cc' <br /> *Effluent#1 =BOD,>30 5 220 m /L and TSS>30 5150 m /L *Effluent#2=BOD,>30<_220 mg/L and TSS>30:5 150 m /L <br /> CST Name(Please Print) Signatur CST Number <br /> kvi�J De-1��1�!s �� J -73�l c� <br /> Address )774r /—I Date galuation Conducted Telephone Number <br /> SBD-8330(R04/15) <br />