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ORIGINAL <br /> 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 /> Comity h{ <br /> Attach complete site plan on paper not less than 8 1/2 x 71 inches in size.Plan must <br /> Lt N y{' <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. 6}•B Qj•7S'OA O 10 <br /> Please print all information. Reviewed by Date <br /> Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). 110 -3-00. <br /> Property OwnerProperty Location <br /> ICh /r Jrn Govt.Lot NW114 J1/61/4 S 34 T qQ N R )/p E(or <br /> Property Owners Mailing Address Lot# Block# Subd.Name or CSM# <br /> 1 w- /3 <br /> City State Zip Code Phone Number ❑City ❑Village gTown Nearest Road <br /> Son r 1 /.01/ <br /> Llnca/ �' <br /> C& New Construction Use:(&Residential/Number of bedrooms__� Code derived design flow rate WO _GPD <br /> ❑Replacement ❑ Public or commercial-Describe: <br /> Parent material XJAC (X J 1)r i 1�p Flood Plain elevation if applicable W/04 ft. <br /> General comments S,J• ¢/r <br /> and recommendations: <br /> Bourn 'QJ- Apri---or, W1d4-- bard of SYR-'Ar P7 S. Q61 Site, u/ifh <br /> Boring 1< Ston Er <br /> Boring# ) A <br /> / ® pit Ground surface elev. Y ft. Depth to limiting factor a in. <br /> Soil Application 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 I 'Eff#2 <br /> t a -4 -7SY4s/ ms ang dl cS "l r ? I-ak <br /> Boring# Boring <br /> Pit Ground surface elev.�� (_ft. Depth to limiting factor _in. <br /> Soil Application Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/If <br /> In. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 •Eff#2 <br /> .0- 3 -;;`ssY4 r M S 43 cl l S h1 - 7 I, <br /> ,1 f3 '7,514 �4 05.9 m 5 5 -- .. -7 /rd <br /> S/� -7,5-Y!?s/ `vr S f7 65 is . 7 1-4 <br /> Z <br /> Effluent#1 =BOD >30<220 mg/L and TSS>30 1150 m91L 'Effluent#2=BOD 130 mg/L and TSS<30 mg1L <br /> CST Name(Please Print) Signature , ST Number <br /> Jl+m S rE <br /> Address Date Evaluation Conducted Telephone Number <br /> '77100 /7w 35" WebiAr✓ wL <br />