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Wisconsin Department of Safety and Professional Services <br /> Division of Industry Services <br /> SOIL EVALUATION REP RT 7 <br /> County Page—Of <br /> in accordance with SPS 383,Wis. Adm. Code C �I " <br /> Attach complete site plan on paper not less than 8 1/2 x 11 inches in size.Plan must <br /> include,but not limited to:vertical and horizontal reference point(BM),direction and ParcelLD.O ^ Od D-oL-yd—I(,-33 -S 1S <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. O1 S- Gi6Gc�(9 <br /> Please print all information, Reviewed y Date <br /> Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). _ �^ <br /> Property Owner Property Location V <br /> Govt.Lot 1/4 114S 33T '/p N R %(C ®r® <br /> Property Owner's Mailing Addres�jZipC:ode <br /> Lot# Block# Subd.Name or CSW <br /> ,L7SdP Re,tc �d -7 / <br /> City State Phone Number ity, O Village Y Town Nearest Road l 7S c7� <br /> Z Z!�/l g f ✓ Wt Sy$13 ( ) CJc lc%�a/ ',e r t r <br /> 0 New Construction UselVI Residential/Number of bedrooms Code derived design flow rate 4 5`4�' GPD <br /> Replacement Public or commercial-Describe: <br /> Parent material Flood Plain elevation if applicable W//9 tt <br /> General comments <br /> and recommendations: S <br /> Boring# Boring <br /> F1 Pit Ground surface elev. <br /> 98' r it. Depth to limiting factor �� in. <br /> Soil A licaflon Rate <br /> HorizonWthColor Redox Description Texture Structure Consistence Boundary Roots GPD/ft <br /> l Qu.Sz. Cont.Color Gr.Sz.Sh. *Eff#1 *Eff#2 <br /> '/ is i� l �/�, 7 1. 67y/y 5'`� es! w. ! 5 a 7 46, <br /> a- 7) 7.5-v/2 — <br /> < <br /> ❑ Boring# Boring <br /> IM Pit Ground surface elev. lea, 3 ft. Depth to limiting factor 7 99° din. <br /> Soil A lication 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. *Eff#1 *Eff#2 <br /> / o k ^�s-rl?�/ 5,4 ,n I �s 3,tii -7 A <br /> . `7 / � <br /> 3 Sy 7,SYR /9 — 3J�r 4-5f <br /> -7 1, E <br /> Effluent#1=BOD >30<220 mg/L and TSS>30<150 mg/L *Effluent#2=BOD <30 mg/L and TSS<30 mg/L <br /> CST Name(Please Print) ignature CST,+^N umber <br /> J ct wf P s S L�ul,r E!spa l vl`r3 cl,� <br /> Address <br /> Date Evaluation Conducted Telephone Number <br /> ol77GG 6 -y l�-P.L -7�e, Jvy�`f&'�i3 F-dLt -17 -715--G y/S7 <br /> SBD-8330(R07/13) <br />