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Wisconsin Department of Commerce <br /> 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 8 1/2 x 11 inches in size.Plan must County Q.�/L-7 <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. <br /> Please print all iriltionnation. Reviewed by Date <br /> Personal information you provide may be used for rAwridary purposes(Privacy Law,s.15.04(1)(m)). <br /> Property Owner Property Location <br /> d/ �'A Govt.Lot 1/4 /ygi 1/4 S // Taj N R �� A�(or)W <br /> Property Owner's Mailing Address Lot# Block# Subd.Name or CSM# <br /> _ <br /> N 9 Etc A let), <br /> City State Zip Code hone Number LJ City ❑Village own Nearest=Roadvn,vE/2 b7 ( ) rf-s / <br /> ❑ New Construction Use:Q Residential/Number of bedrooms Code derived design flow rate ,3DJ GPD <br /> ❑Replacement ❑ Public or commercial-Describe: <br /> Parent material r/;� Flood Plain elevation if applicable NR ft. <br /> General comments <br /> and recommendations: <br /> Boring# Boring <br /> ❑ pit Ground surface elev. ft. Depth to limiting factor in. <br /> Soil Applicetion Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz <br /> in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 'Eff#2 <br /> 45 I s my _7 <br /> 5_ - <br /> g3•r3 <br /> by r <br /> W � r <br /> Ll Boring# ❑ Boring <br /> ❑ pit Ground sprface eli v. ft. Depth to limiting factor in. <br /> Soil Application Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 <br /> in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 'Eff#2 <br /> Effluent#1 =BODS>30<220 mg/L nd TSS>30<150 mg/L 'Effluent#2=BOD5<30 mg/L and TSS<30 mg/L <br /> CST Name(Please Print) Si natulp CST Number <br /> Address Date,Evaluation Conducted Telephone Number <br /> 7316 <br /> S- <br /> SBD-8330(R07/00) <br />