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Wisconsin Department of Safety and Professional Services �c`� IQ�� Page of <br /> Division of Industry Services J l 7 <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, r "N 4 <br /> tH- <br /> but not limited to:vertical and horizontal reference point(BM),direction and percent slope, Parce 1 D (�•- 'p _ y - //c'rr Ei <br /> scale or dimensions,north arrow,and location and distance to nearest road, o?�ba0 <br /> Please print all information. wed b Dat <br /> Personal information you provide may be used for seconds purposes(Privacy Law,s.15.04(1)(m)). �-C) ,t01q <br /> Property Owner Property Location ❑ <br /> C#-io 5 Z/-&- '}0 ri Govt.Lot '/< Y< S ?6, T ` O N R /C, E (or) W <br /> Property Owner s Mailing Address Lot# Block# Subd.Name or CSM# <br /> City State Zip Code Phone Number ❑cit <br /> y El Village Town Nearest Road (004.11 <br /> ❑ New Construction Use:®Residential/Number of bedrooms 3 Code derived design flow rate i�o GPD <br /> ® Replacement � El Public or commercial-Describe: <br /> Parent material f,-1 f G i e- ( J-" ` r( Flood Plan elevation if applicable Nb,ft. <br /> General comments and recommendations: syj el'ev .3 y, <br /> Boring# ❑Boring <br /> ®Pit Ground surface elev. tt. 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 I *Eff#2 <br /> 1 6- l 0 7.Sy?- 36- — 1,5 /�-,sb & I e s 3 r . 7 11, 6 <br /> y3-5 1 7.S`11? �M3 6% 1 (y S — 7 A 6 <br /> ® g ❑Boring Boring# ®pit Ground surface elev. '4ft. Depth to limiting factor 7 7�in. <br /> Soil Application Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/FC <br /> In. Munsell Qu.Az.Cont.Color Gr.Sz.Sh. *Eff#1 *Eff#2 <br /> w- 37 ?.s`riz "/11 Yr=s );" Gj 3r0- ' 5- <br /> 3 3-7T-7) h=3 /C <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 m /L <br /> CST Name(Please Print) Sign at a CST Number <br /> .,A.1•1 e s 1 (x I I-e IS S i-;) r— // j -7 ild 6, <br /> Address 1 77(e e 1' -Y 3"' Date' valuation Conducted Telephone Number <br /> w rh St e <br /> SBD-8330(R04/15) <br />