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Wisconsin Department of Commence SOIL EVALUATION REPORT PaSe-j—of <br /> Division of Safety and Buildings <br /> in accordance with Comm 85,Wis. Adm. Code <br /> Ift <br /> Attach complete efts Corm <br /> d plan on paper not less than 8 1/2 x 11 inches in size.Plan must <br /> include,but not limited to:vertical and horizontal reference point(BM),direction and Parcel I.D. <br /> percent slope,wale or dimensions,north arrow,and location and distance to nearest road. O b 3 �6OQ <br /> Please print al!information. Reviewed Date <br /> Parsonar it formation you prey'"may M used for secondary purpose(Privacy Lsw,S.15.04(1)(m))• <br /> Property Owner Property Loradon <br /> Sa r✓kGovt Lot NE 1/4 A/� t/4 S d T N R <br /> Property Owners Mailing Address Lot S Block* Subd Name or CSW /6 E(or) <br /> 1616-6- 08 eh 574• <br /> Crh State zip Cade Phone Number ❑City ❑Village 0 Town Nearest Road <br /> Cenfer^ Cif ln� SSo/} (/,si ) 57- X981k,1411 ( 1 5 Gwll T,-Ik <br /> 12 New Construction Use: Residential/Number of bedrooms Code derived design Sow rate _ 3,00 GPD <br /> ❑Replacement ❑ Pubic or commercial-Oesaibe: <br /> Parent materialFlood Plain elevation if applicable <br /> GeWW connants Sys ellfd 4p per q� <br /> and recommendations: <br /> /owtr 90.9 <br /> MIBoring 0 <br /> ❑ �+g <br /> ® Pit Gramd surface ells, 97 / R Depth to imiti g taeeor 7 8/ in. <br /> Horizon Depth Dominant Redox Deemtion Texture Structure Roots e Consistence GPDn!$Oi A°OPOM Rate <br /> in. Munsell OU.Sz. Cont Color Gr.Sz.Sh. •EAu1 'EA11112 <br /> / o_ b . .�sY9�/� _.. >s /i►s6�' m ! c s 3�0 . 7 <br /> � 6'j 0 7.S yIQ 4`�- �. ..._ �S - d•�yts b.E r`t f G S 3 C0 .S 9 <br /> Boiling 0 Q Boiling <br /> 1 <br /> 1 <br /> 0 Pit Ground surface slev. 77 41f R Depth to limiting factor > � in. <br /> Soil Aoclieation Rate I <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPOIM I <br /> In. Munsell Ou.Sz. Cont.Color Gr.Sz.Sh. •E..fx1 'E."X2 <br /> l <br /> 0 - 4 y SYR 3/� -- 1 /s /•rudk m 1 c s -311-0 ( r-7 <br /> 6-35 7•57M <br /> 3 <br /> -WI 7.5'M 6 — /FS d n+a.S k t G 5 ++ 1 S <br /> `-j 05 6- rY) t 65 7 1 <br /> 1 1 � <br /> Effluent$1 =BOD �30<120 and TSS>30<150 •E?M _ <br /> _ �L _ nglL rent x2 BOD 130 ngrL and TSS<30 mgrt <br /> CST Name(P,-~ °'"r% Signature CST Vtxrger <br /> JNIhE3 5. Orrwi6/S s��u1 r 60 3 V&- I <br /> Addrou to Evaluation Conducted Telephone Number 1 <br /> ZI7f0 3 d /cr UJ.• 5' 7-31-03 (7/fl- 'q/57 <br />