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ORIGINAL <br /> Wisconsin Department of Commerce SOIL EVALUATION REPORT Page I of 3 <br /> Division of Safety and Buildings <br /> in accordance with Comm 85,Wis. Adm. Code <br /> County <br /> Attach complete site plan on paper not less than 8 1/2 x I 1 inches in size.Plan must <br /> Include,but not limited to:1l�1vertical and horizontal reference point(BM),direction and parcel I.D. 0 7-0/a-d^ D,/ <br /> percent slope,scale or cll pensions,north arrow,and location and distance to nearest road. /S 00 - O A b coo <br /> #3/ease print all information. Review b Date <br /> Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). I J 1. <br /> 11 <br /> Property Owner Property Location J C(l <br /> MCI,. I H Fn 7t--r, Govt.Lot 1/4 1/4 S Ar T I/O N R /S'E(or)� <br /> Property Owner's Mailing Address Lot# I Block# Subd.Name or CSM# <br /> 90 9 E . cl ,�,!ti St M— CLEAP- 640 AC kr-S <br /> City Stage Zip Code Phone Number ❑City ❑Village [$Town Nearest Road <br /> /Vor+41 10c0/YW 5-S'o ((wt ) "Cf- 7 JAdc-f&ct s/e'r Re <br /> Eff New Construction Use:® Residential/Number of bedrooms_� Code derived design flow rate 300 GPD <br /> ❑Replacement j ❑ Public or commercial-Describe: <br /> Parent material.. _ �r�K G'i(4. ©r �f°• Flood Plain elevation if applicable N ft. <br /> General comments �I rr pQti r �i•� � 3T £p 93. OJ <br /> and recommendations: ) <br /> and recommendations: 1-4 U <br /> �e fw ai IV. oo C 88.00 �e Ro.So) <br /> M as 383 9TDW5D1 I-oAMX fAOD <br /> Boring# ❑ Boring <br /> ® pit Ground surface elev. �ft. Depth to limiting factor 7 cFU in. <br /> Soil Application Rate <br /> Horizon Depth Domin nt Color Redox Description Texture StructureConsistence Boundary Roots GPDAF <br /> in. Mu ell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 I •Eff#2 <br /> / o- 7.S S/i — /s .,rsb/c cs xK, -71 6 <br /> 3co . 7 I• e- <br /> ® Boring# ® Boring <br /> ❑ Pit '.. Ground surface elev. 9/ ✓�ft. Depth to limiting factor 7 in. 911 lica8on Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF <br /> in. Msell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Etf#1 •Eff#2 <br /> 3 ?f•�p 7,s 7 y/4 — s . 7 /, 6 <br /> Effluent#1 =OOD,>30<220 mg/L and TSS>30 1150 mg/L 'Effluent#2=BOD 130 mg/L and TSS<30 mg(L <br /> CST Name(Please Print) — Signature CST Number <br /> iames /� 7.34,10 <br /> Address Date Evaluation Conducted Telephone Number <br /> � 7760 r54.. 3s (.(Jebs fpm w2- .s48s3 �'0�9- // Zis- 8'66- 4ys7 <br />