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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 EgAhKw <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. <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)). l <br /> Property Owner Property Location <br /> J �} Govt.Lot 1/4 1/4 S V T 40 N R E(or W <br /> Property is Mailing Address Lot# Block# I Subd.Name or CSM# <br /> C' State Zip Code Phone Number ❑City ❑Village Town Nearest Road <br /> W I 16f993 1 ( 65) G Dgwwwp <br /> tW New Construction Use:®Residential/Number of bedrooms Code derived design flow rate _ GPD <br /> ❑Replacement ❑ Public or commercial-Describe: — <br /> Parent material GL>Acw wjyr Flood Plain elevation if applicable � ft. <br /> General comments <br /> and recommendations: <br /> EL L75.s <br /> Boring# <br /> Boring <br /> IBl pit Ground surface elev. ft. Depth to limiting factor 7 /s_in. <br /> Soil lication 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 /> 2 i-?+ 7 R ¢ �— /s 1 �s -7 /.7. <br /> 3 ?A-7F ' 7 /.z <br /> Boring# Boring -�//<F �/ <br /> Pit Ground surface elev.7 ft. Depth to limiting factor.> 7t—y in. <br /> Soil Application Rate <br /> Horizon Depth Dominant Color Redox Description Texture StructureConsistence Boundary Roots GPD/(F <br /> in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 'Eff#2 <br /> 1 .6 .1 s 1 ►� . 7 i.2 <br /> y 6 3 f AkA Ad Ct .7 z <br /> .11 <br /> Effluent#1 =BOD >30:S 220 mg/L and TSS>30<150 mg/L 'Effluent#2=BOD,:5 30 mg/L and TSS 130 mg/L <br /> CST Please Print) — — 'gnature CST Number <br /> 104 4 2_2S 8:!;j <br /> Address Date Evaluation Conducted Telephone Number <br /> 2-m,,o 14wv 33' Ug&5Ti� 6J1- S4SI3 2-2Z-oi /s- - �S7 <br />