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Wisconsin Department of Safety and Professional Services <br /> Division of Industry Services <br /> SOIL EVALUATION REPORT Page 1 of 10 <br /> in accordance with SPS 383,Wis. Adm. Code C%-�7 <br /> N L - <br /> Attach complete site plan on paper not less than 8 1/2 x 11 inches in size.Plan must County R u.0 <br /> include,but not limited to:vertical and horizontal reference point(BM),direction and Parcel I.D.O 7 <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. voo-of Hoo 0 <br /> Please print all information. Reviewed by Date <br /> Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)), a/Avve—, rf <br /> ProperryOwner Property Location 4 i- 0 <br /> {� r~ /h S-�c Y F Govt.Lot 1/4 1/4 S of$ T y/ N R /G/ E0(or)W <br /> Property Owner's Mailing Address Lot_# Block# Subd.Name or CSM# A r 0$ <br /> 3 o 3�t 8 G o IiEd N J� V. /d <br /> City State Zip Code Phone Number ®City ®Village Y Town Nearest Road 30 3,( 8 <br /> �.✓e bb L l� W- SYY3 c ( ) w�b & o 4�1 <br /> New Construction UseC] Residential!Number of bedrooms Code derived design flow rate y�� GPD <br /> Replacement ® Public or commercial-Describe: Arc-A i/ 57Ca.- to <br /> Parent material 4 /A e- Flood Plain elevation if applicable <br /> General comments ./ <br /> and recommendations: , s, e8o <br /> 1-4180fat as 39 B Gra Y calue.-nsti 5 d <br /> I❑ ®Boring# Boring <br /> ® pit Ground surface elev. ofS• 3 ft. Depth to limiting factor > oqo� in. <br /> Soil Application Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff <br /> in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff91 I 'Eff#2 <br /> vf <br /> of W- d 1! 7 S YR% <br /> 3 ys` 7sy/7% s et,sG. � � l c� IF -7 /, 6 <br /> Boring# Boring <br /> ❑ Pit Ground surface elev. `jS ft. Depth to limiting factor > 7? in. <br /> Soil Application Rate <br /> Horizon Depth Dominant Color Redox Description Texture StructureConsistence Boundary Roots GPD/ff <br /> in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 I 'Eff#2 <br /> / m "y 7.Sy�3f� !S /c,sb/� H / < • 7 1, 6 <br /> of -a8 7.s-Y2'/A, 5 osG ,., t GS 3co A 6 <br /> J� sy .5-17�?% — s osG , , l Gs . 7 l G <br /> Effluent#1 =BOD >30<220 mg/L and TSS>30<150 mg/L Effluent#2=BOEs<30 mg/L and TSS<30 mg/L <br /> CST Name (Please Print) Signat e CST Number <br /> s .5 1 , /-S s0 -.ZZ -234414115, <br /> Address V Date Evaluation Conducted Telephone Number <br /> 7 3 - 56t6— 0s7 <br /> SBD-8330(R07/13) <br />