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Wisconsin Department of Commerce SOIL EVALUATION REPORT Page—4--Of <br /> Division of Safety and Buildings <br /> in accordance with Comm 85,Wis. Adm. Code <br /> 13urneTJ` <br /> Attach complete site plan on paper not less than 81/2 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 /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. L�- <br /> Please print all information. Reviewed b Date <br /> Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). O 16 <br /> Property Owner Property Location <br /> /✓Q NGY Ay kA Y GovL Lot 1/4 1/4 S 7T 40 N R /q E(or)e <br /> Property Owner's Mailing Address Lot# Block# Subd.Name or CSM# <br /> /63,20 S. c-itro( C#--/- S'y S rrn Green /4doe <br /> City State Zip Code Phone Number ❑City ❑Village ®Town Nearest Road <br /> r✓Irnon w.r 1.S-4'0s9 I ( I .SGort I f/4Lk <br /> 1R New Construction Use:® Residential/Number of bedrooms 3 Code derived design flow rate q.S d GPD <br /> ❑Replacement ❑ Public or commercial-Describe: <br /> Parent material 6'4e/o—/ Flood Plain elevation if applicable N/fy ft, <br /> General comments ,r yS•O <br /> and recommendations: s/s e /Pv. PP 94. 4.0 9S.tav RANGE , 5rS1SL°Mr I! <br /> Boring# ❑ Boring <br /> ® pit Ground surface elev. 7t10• ft. Depth to limiting factor Sot 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 /> 6-4 7•ssi�3',t — /f o .•r / c.s 3.•Y, . 7 1. 6 <br /> of y-.rA 7S-'r/t y/4 — /s a l G s ace, . 7 /. 6 <br /> 3 St-S9 2S Y/t 4/y F/F S f?%£� /S O �n / G S m . -7 <br /> �( s-9- S8 SYR 4/-v Per f"r G S -- _T- <br /> 40 1, O <br /> Boring# ❑ Boring <br /> Pit Ground surface elev. ft. Depth to limiting factor >60 in. Sal 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 /> o� <br /> 0- 41 - .r r/?% — /s to wr I cs 3.r I .7 1- 6 <br /> 3 y- yo 7.sy/?f/y — is a / Gs 3�0 . 7 /.6 <br /> 5' Ya- ilf 7-'rrlt' Y/4 — /FS i:f <br /> m . S' /. O <br /> S -f-r- 60 <br /> Effluent#1 =BOD >30:5 220 mg/L and TSS>30:5 150 mg/L 'Effluent#2=BOD,:5 30 ng& acct TSS<30 nglL <br /> CST Nam(Please Print) Signature CST Number <br /> Address Date Evaluation Conducted Telephone Number <br /> dk7760 93 /o-dam oe,' ?is- 866-�r/r7 <br />