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1 ^ NAWisconsin Department of Commerce SOIL EVAL30F!1 4? Page of <br /> Division of Safety and Buildings <br /> In accordance with Comm 85,Wis. Adm. Code <br /> Attach complete site plan on paper not less than 8 1/2 x 11 Inches in size.Plan must County �U Q/t.1 G <br /> Include,but not limited to:vertical and horizontal reference point(BM),direction and Parcel I.D. _ <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. t 3Z - �S Z S•p/— D O <br /> Please print all Information. Revievjed by Date <br /> Personal Information you provide mey be used for secondary purposes(Privacy Law,s.15.04(1)(m)). /0--( <br /> Property Owner Property Location <br /> 's—,r>6 P✓'k1 6XgS Govt.Lot N 0 1/4 1/4 S a£{ T N R 1 b E <br /> Property Owner's Melling AddressLot# Block# Subd.Na a or CSM# <br /> o�� sT v 51 � Ste, a� <br /> City State Zip Code Phone Number ❑City ❑Village RTown Nearest Road <br /> ! 9OOU80P- AJI 1 5-VO30 ( 7/I) 65-6 - 3 Y7 SwrSS 0.9<< S7• <br /> ❑ New Construction Use:❑ Residential/Number of bedrooms 42 Code derived design flow rate 300 GPO <br /> Replacement ❑ Public or commercial-Describe: <br /> Parent material Flood Plain elevation if applicable g, <br /> General comments <br /> and recommendations: <br /> a Boring# ❑ Boring <br /> pit Ground surface elev. MO® c © ft. Depth to limiting factor 56 in. <br /> Soil Application Rate <br /> HorizonjDepthDominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftl <br /> Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. •Eff#1 •Eff#2 <br /> 73'12 y14LS�fer3, !FS$K VriV/7Z GS -7 1 Z <br /> zZ Slo 75HR S�G .s�" �N)Sl9l� Vim1� 'Z <br /> Borin <br /> g# ❑ Boring <br /> Fal ® Pit Ground surface elev. 1 p�'r� ft. Depth to limiting factor �'s8 ` in. <br /> Soil Application Rate <br /> Horizon Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Roots GPD/ft' <br /> In. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. •Eff#1 •Eff#2 <br /> L o �,awn"5/2 s <br /> �r~s,,,tMM/)r:a s .-7 112 <br /> 12 1//4- 144 r..F/1- 601, 2 <br /> 2V 58 '7•�-qI2 s� C 5 wiSn ,MFl2 S I'� <br /> •Effluent#1 =BODr>30<220 mg&and TSS>30<150 mg/L •Effluent#2 a BODS<30 mg/L and TSS<30 mg/L <br /> CST Na (Please Print) SI CST Number <br /> Address Date Evaluation Cbndudted Telephone Number <br /> (� <br /> 712;) <br />