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Wisconsin Department of Safety and Professional Services <br /> Division of industry Services <br /> SOIL EVALUATION REPORT <br /> Page_of_ <br /> in accordance with SPS 383,Wis. Adm. Code CST I 1 <br /> Ca my <br /> Attach complete site plan ve paper not less than 8112 x 11 inches in size.Plan must <br /> percent but not limited di vensioand horizontal reference point(distance <br /> and Parcel 10.07 (7/ Z 39 /6 a6 <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearestreet, �/5— G SpOFJ <br /> I Please print all information. Reviewed by / Date <br /> Personal information you provide may the used for secondary purposes(Privacy Law,s.is 04(1)Im11. 69,4/b <br /> Prope .'w / Property Location y{�J <br /> �/� HIG�2� Govt.Lot 1/4 1145 y/ T,3e N R ©r)W <br /> Property Owners Mailing Add s Lot Block# Subd. ameauC8AN1 r <br /> 4r3/S �laN�sf nK� /Ne-s <br /> City State Zip Code Phone Number ity ❑Village Town Nearest Road r <br /> ❑ New Coustructil Use® Residential(Number of bedrooms Q Code derived design flow to GPD <br /> Replacement ❑ Publicorc ri rcial/Describe: <br /> Parent material J�3-5— J'I-tl �Y/ /=�� Flood Plain elevat,cd,f applicable fl. <br /> General comments <br /> and recommendations'. <br /> ,ll —') NnG 70-r9&NC9M"f SkJptb f3- 77&2) TD RF6.4 EZF.fMWW tee f6riz- ✓cab 7sr�oP. <br /> Boring# ❑ Boring ) <br /> _ Pit Ground surface elev.� �C <br /> R. Depth to limiting factor ; in. Soil Apollcation Rate <br /> Horizon Depth Dominant Color Redox Description Texture Strocture Consistence Boundary Roots GPD/fe <br /> In. Munsell On Sz. Cont.Color G,Sz.Sh. 'Elf#1 I 'Eff#2 <br /> 6- s s / 7 <br /> d❑�7 <br /> Spring if © Baring <br /> _ ❑ Pit Groundsurfaceelev. ff. Depth to limiting factor_ in. <br /> Sell Application Rale <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary RootsJGPD/ffin. Munsell Co.Sz Cont.Color Gr.Sz.Sm-/ /z� .� PYl — /sI -ILL3 7-s ei>/ of 22 <br /> Effluent#1 =BOD >30<220 mgt and TSS 130<150 mail 'Eflluem#2=BOD <30 mg/L and TSS<30 mi <br /> CST Name (Please Pont) Signature CST Number <br /> Wade RhAholm 2: <br /> Address n Date Evaluation Conducted Telephone Number <br /> PO Bax 514, Siren,WI 54872 9j —12,7 <br /> ,7—/ (715)349-7286 <br /> SU6tlJJe(KO]/p) <br />