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Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of `— <br /> Division of Safety and Buildings <br /> in accordance with Comm 85,Wis. Adm. Code <br /> County /3 c.r n e ' <br /> Attach complete site plan on paper not less than B 1/2 z 11 inches in size.Plan must <br /> include,but not limited to:vertical and horizontal reference point(BM),direction and parcel <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. <br /> Please print all information. Rev ew Date <br /> Personal informalion ou vide may be used for s nda r <br /> Y pro Y ry purposes(Privacy Law,s.15.04(r)(mp. j C � Oj <br /> Property Owner _ Property Location l)/ <br /> P�I� / /�101ngL A GovL Lot 1/4 1/4 S S T N R /4-E(or W <br /> Property Owners Mailing Address LotBlack# Subd.Name or CSM# <br /> �r14 9 t�a,N�C On�" `N <br /> City State Zip Code Phone Number City ❑Village ®Town Nearest Road <br /> 0. I#JAI 1 f3'3o3 1 (76 3 )'l 7-S'/7#k ao rt I Birt ra.4 <br /> ® New Construction Use:® Residential/Number of bedrooms_ Code derived design now rate �J.S—U GPD <br /> ❑Replacement ❑ Public or commercial-Describe: <br /> Parent material a1"Fe,( 0 1-{1- Flood Plain elevation if applicableGeneral <br /> and recommendations: <br /> banets vtr5 rn horrteh J <br /> r. I <br /> Lower- 9S <br /> 1 <br /> Boring ❑ Boring <br /> # p Q <br /> ® pit Ground surface elev. /�' f ft. Depth to limiting factor 5-3 in. <br /> Soil Application Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP Mf <br /> in. Munsell Ou.Sz. Cont Color Gr.Sz.Sh. 'Eff#1 'Eff#2 <br /> s 0-4 7.fY/( '�1- - /s /In 5j le- C- -7 l yh <br /> W-J4 7,SYR '/ If msb It mfg GS 3G0 '3- <br /> 3 Y-n 1 7..'57'14 V t¢s dtn.$6k. rn it s d. . .5✓ l <br /> r <br /> f 7-r- SrA %v G Ad sw % FS Msbk ynvf, <br /> I <br /> I � <br /> I 1 j Borina# ❑ Boring f <br /> I I Il�f Pit Ground surface elev. If ff. Depth to limiting factor in. <br /> Soil Ao licatlon Rate j <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff <br /> in. Munsell Qu.Sz. Cant.Color Gr.Sz. Sh. I 'Eff#1 -Eff#2 <br /> 1 0- ;IS"M 3/J. /S lm k m/ G S 3 I:p -7 <br /> r 0/ '-- rrs J.M'S'6/Z 0"6r- 65 <br /> y,s' V' VCS j\ft,sd/r, I r•,fr GS <br /> 9*--f8 7XM Vfl e-f b„m q/a miEr (r S <br /> SfIXY-e-191Jr-Ifill <br /> Effluent 91 =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) - Signp^— CST Number <br /> _a 73 4 A L7 ii <br /> AddressV Date Evaluation Conducted Telephone Number <br /> 47,760 3 W d 5><e� LU." S` 3 s'�-0 67/t) - x!/57 <br />