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Wisconsin De ORIGINAL f <br /> Department SOIL EVALUATION REPORT page—of ,3 <br /> Division of Safety and Buildings <br /> in accordance with Comm 85,Wis. Adm. Code <br /> E <br /> Attach complete site plan on paper not less than 81/2 x 11 inches in sae.Plan must Carty <br /> include,but not limited to:vertical and horizontal reference point(BM),direction and parcel LD o <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. C)�:(J /170 "Q Z <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)). <br /> Property O^er Property Location l' / <br /> Govt.Lot 1/1.:� t 1/4 S7_9 T T D N R E(or)W <br /> Property Owner's Mailing Address / Lot# Block# bd.`Name or CSM* /d <br /> 1161110 UAW J,-,11157 �C N �— a n� .3'�q f£S <br /> ,CA-Y State Zip Code Phone Number ❑City fr'I/� Villa ®Town <br /> L)OO ,L i[,V• i! /d v <br /> New Construction Use: Residential/Number of bedrooms Code derived design flow rate Sd GPD <br /> ❑Replacement ❑ Public or commercial-Describe: <br /> Parent material Flood Plain elevation if applicable fL <br /> General comments <br /> and recommendations: <br /> z = 9s 7 <br /> F—/ <br /> Boring# E�]I ung p�.� <br /> tSl pit Ground surface elev. ft. Depth to limiting factor—t--0'0 in. <br /> Sal Application Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure RCOnsistenoL Boundary Roots GPD/fF <br /> in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. •Eff#1 •Eff#2 <br /> GtS /• <br /> Boring# Ing <br /> ® Pit Ground surface elev. ft. Depth to limiting factor (P in. <br /> Sal Application fiats <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 •Ef1#2 <br /> a '5 %/Z - ,,n as - 7 v <br /> W 69 a 1,10y l OL <br /> Sv <br /> •Effluent#1 =BOD >30:E 220 mg/L and TSS>30<150 ng/L •Effluent#2=BOD,:5 30 mgjL and TSS<30 ng/L <br /> CST (Please Print) Signa CST Number <br /> r' C �lw /vs 2ZZ87 <br /> Addre 4hl Date Evaluation Conducted Telephone Number <br /> ibis a u aL)6- /L(( lti/' 2FPsi IL- s-o Z-- vzz -aYzl <br />