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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 /> Attach complete site plan on paper not less than 81/2 x 11 inches in size.Plan must County 13t e pile yi- <br /> include,but not limited to:vertical and horizontal reference point(BM),direction and parcel I D p7 0 A O ot NO 4 4 0 ori <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. 0//004 <br /> Please print al/information. Reviewed by C , �, Date <br /> Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). <br /> Property Owner y� Property Location <br /> DA // r Gtr /1Y Govt.Lot 5i 1/4 /(f 1/4 S 4 S T z/p N R /4 E(or)6 <br /> Property Owner's Mailing Address Lot# Block# I Subd.Name or CSM# <br /> X.%5-7 )'s'-*)' /4 v e A1,6- <br /> city State Zip Code Phone Number ❑city ❑Village ®Town Nearest Road ) 7SS0 <br /> ,6ast /v 5:ro0.S ( ) C.A k 1A-d- 1 /?066,r /?W. <br /> ® New Construction Use: Residential/Number of bedrooms o— Code derived design flow rate -700 GPD <br /> ❑Replacement ❑ Pudic or commercial-Describe: <br /> Parent material G lG 1-1 w / /J,.; �y Flood Plain elevation if applicable A+114 g, <br /> General comments d. C®C J u�� e✓ yA• 9 <br /> and recommendations: s r <br /> !mw t^r 91. 9 <br /> Boring# ❑ Boring <br /> © Pit Ground surface elev. `JL•S ft. Depth to limiting factor >4F/ in. <br /> Soil Application Rate <br /> Horizon Depth I Dominent Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF <br /> in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 I 'Eff#2 <br /> / v- 8 7Sy/?7�� -- /S /msL c s 3vF .7 /- 4 <br /> /F l o?.»Jb/C /,, I G I VF S— /. d <br /> G- �! 7•S-Yi7`�Ta _ S�6r O.SG /,, I — — <br /> . 7 6 <br /> a Boring# Boring <br /> pit Ground surface elev. We, y ft. Depth to limiting factor .7 3 in. <br /> Soil Application Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/f? <br /> in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 I 'Eff#2 <br /> / 0- 8 76"YR 3l _ /S /x.'66 �* I c s $.F 7 /, 6 <br /> . 7 /, 6 <br /> -3 Ap-yo 11'K — s/6r• os <br /> ' <br /> Effluent#1 =BOD >30<220 mg(L and TSS>30:5 150 mg/L •Effluent#2=BOD,:5 30 mg/L and TSS<30 mg/L <br /> CST Name(Please Print) - Sire CST Number <br /> James 5L-)407 e/'.S Signature Z) 7340)0 <br /> Address Date Evaluation Conducted Telephone Number <br />