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Wisconsin Deparliment of Commerce SOIL EVALUATION REPORT Page_Lofy$ <br /> Division of Safety and Buildings <br /> in accordance with Comm 65,Wis. Adm. Code <br /> Attach complete site plan on paper not less than 8112 x 11 inches in size.Plan must <br /> county QkrN e7t'— <br /> include,but not limited to:vertical and horizontal reference point(SM),direction and Parcel I.D. <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. <br /> Please print all information. Reviewed by Date <br /> Pmsonai infomweon you provide may os used for secondary purposes(Privacy Law,s.15.04(1)(m)). 9 07 <br /> Property Owner Property Location <br /> Li.e v of a h M Irl Govt.Loth 1/4 1/4 S I I T /149 N R /6 E(or)d'® <br /> Property Owner's Mailing Address - Lot# Block# Subd.Name or CSM# <br /> V 335 R'rs Ln <br /> City State Zip Cade Phone Number ❑City ❑Village ®Town Nearest Road <br /> ire(✓enrol/r .AN e4A7 1 ( ) OsK/en Ca Re( <br /> �J New Construction Use:® Residential/Number of bedrooms Of Code derived design flow rate 3 e GPD <br /> ❑Replacement ❑ Public or commercial-Describe: <br /> Parent material_ G/ac i..( 0"'41& Flood Plain elevation if applicable /y1149 ft. <br /> and recommendations: <br /> mmendas r1 Y 00(06 97.00 /I <br /> and recommendations: S j✓. elev. �PP"'^ � <br /> /cwt r 5+.)4W 92.90 60 W.X) <br /> ft yCA -,vf4 T. H/fti i A4.4,97DAWpi Sou $� <br /> Boring# ❑ Boring <br /> ® Pit Ground surface elev. 9G' ft. Depth to limiting factor > 7y in. <br /> Shc kation Rate <br /> Horizon Depth Dominant Color Redox Description jTwdluire, ;Sz,.:Sh. <br /> re Consistence Boundary Roots GPD/hF <br /> in. Munsell Ou.Sz. Cont.Color G 'Eff/M •Eff#2 <br /> c d f Tco <br /> ® Boring# ❑ Boring <br /> ® Pit Ground surface elev. ft. Depth to limiting factor > 7r in. <br /> Soil Application Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF <br /> in. Munsell Cu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 •Et111#2 <br /> / 0-4 7. rkt*?'�/ /S jhAC 7 /. <br /> d of- .7b 7r'rRV/1k _ /Ft ,os6k J..l a3 3co <br /> 3 G-78 7.r'fR'y5 /F s .A.as6 A ,r l <br /> Effluent#1 =BOD >30:5 220 rrg/L and TSS>30<150 mg/L 'Efeuent#2=BOD <30 mg/L and TSS:5 30 nVL <br /> CST Name(Phase Print) — — Signatu CST Number <br /> -jr of 73`/Jl C) <br /> Address Data Evaluation Conducted Telephone Number <br /> Gve&$7 er bV r— dg3 9-1A 7 7/s- Sri;4- Srs-7 <br />