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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 /> Attach complete site plan on paper not less than 8 1/2 x 11 inches in size.Plan must County <br /> include,but not limited to:vertical and horizontal reference point(BM),direction and Parcel I.D. <br /> Dpercent slope,scale or dimensions,north arrow,and location and distance to nearest road. <br /> Please print all information. Reviewed by Date / <br /> Personal information you provide maybe used for secondary purposes(Privacy Lew,s.15.04(1)(m)). K6 , '0( <br /> n Il <br /> Property Owner Property Location <br /> Govt.Lot 1/4 1/4 S 2- T N R E(J)IW <br /> Property Owner's Majling dress Lo # Block# Name or;710 CSM# <br /> VnrJa` t I APA o,. V-V, <br /> City State Zip Code Phone Number ❑City ❑Village own +Nearest Road <br /> UOMwl S l(o c I ) -15q% q E <br /> New Construction User Residential/Number of bedrooms 2 Code derived design flow rate GPD <br /> C3 Replacement ❑ Public of commercial-Describe: <br /> Parent material "Ai fV Flood Plain elevation if applicable <br /> General comments <br /> and recommendations: <br /> F-1 Baring# ❑ Boring <br /> pit Ground surface elev.1.5 ft. Depth to limiting factor 2V 9 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 •Eff#2 <br /> l S s 91/ .1 l-z <br /> S4¢ d s I Co .-7 J. Z. <br /> If-Ap .S 4 s a s -L)&-!- 7 J•Z <br /> Boring#` Boring <br /> I I ❑ Pit Ground surface elev.q�ft. Depth to limiting factor _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 'Eff#2 <br /> / Gt S <br /> 2 6 ` s <br /> 3 6-66 <br /> Effluent#1 =BOD >30:a 220 mg/L and TSS>30<150 mg/L •Effluent#2=BOD <30 mg/L and TSS<30 mg/L <br /> CST (Please Print) _ - 9 lure _ CST Number <br /> Lit ! 17.25$SI <br /> Addrest Date Evaluation ConductedTelephone Number <br /> 27760 Avf 3� UQ;S? ,2 W1- SSI .DI 7t'� 8(6- +S7 <br />