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Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of 3 <br /> Division of Safety and Buildings <br /> in accordance with Comm 85,Wis. Adm. Cade <br /> Countyr"_f� <br /> Attach complete site plan on paper not less than 8112 x 11 inches in size.Plan must c.�� <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. O/ <br /> S 7 7� <br /> Please print all infonnation. Reviewed hvn Date <br /> Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). 12— 07 "b <br /> PropeW76'k <br /> , er Property Location <br /> Govt.Lot 1/4 1/4 S 23 T 40 N R 15 rt(or)w <br /> Property Owner's Mailing Address Lot# Block# Subd. Name or CSW <br /> 23O/-hGl/-E <br /> city State Zip Code Phone Number p city ❑Village ®Town Nearest <br /> Road <br /> b4pv,�� /'W16-j'03-3 (CTlonr ) 73, 03 ^ v UYi <br /> L), Fr tf. <br /> [�tJ New Construction Use: Residential/Number of bedrooms z Code derived design flow rate ado GPD <br /> ❑Replacement ❑/public or commercial-Describe: <br /> Parent material Flood Plain elevation if applicable ft. <br /> General comments <br /> and recommendations: <br /> Boring <br /> T] <br /> Boring# ffe�l 9 O 7 7 <br /> K� pit Ground surface elev.�ft. Depth to limiting factor in. <br /> Soil kation Rate <br /> HorizonkDepthDominant Color Redox Description Texture Structure Consistence Boundary Roots GPDliF <br /> Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 'Eff#2 <br /> I �Y L G 5 ZI-2 -776WIll <br /> 7.5 t9r�L GS i U O <br /> Boring# 0 Boring p ') <br /> Z ® pit Ground surface elev. / v ft. Depth to limiting factor 779 in. <br /> Soil lication 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 T 'Etf#2 <br /> 0-41 4Im4k r,L Z- a . 7 //,, <br /> /- 7 <br /> Effluent <br /> 0 �� �5 A/912- v <br /> Effluent#1 =BOD >30<220 mg(L and TSS>30<150 ng/L 'Effluent#2=BOD <30 mgA and TSS<30 mg/L <br /> CST Ny (Please Pri ) ,SynaN�re CST Number <br /> Address Date Evaluation Conducted Telephone Number <br /> 'o/ G -y <br />