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Wisconsin Departmenty and Professional Servi Page of <br /> Division of Industry Se <br /> JUL - 9 2021 _ � � <br /> VALUATION REP RT <br /> CnAGGaujajjcewi4SPS 385,Wis. Adm. Code County f � <br /> Attach complete site plan p ches i size.Plan must include, - <br /> but not limited to:vertical on and percent slope, Parcel I.D. 7 C scale or dimensions,north arrow,and location and distance to nearest road. <br /> Please print all information. Reviewed by /_ f -Date <br /> Personal information you provide may be used for secondary purposes Priva Law,s.15.04(1)(m)). vv 7/Z Zi <br /> Property Owner Property Location l 0 t� <br /> l'W t Y7 Govt.Lot '/. '/. S i// T 70 N R E (or)W <br /> Property Owner's Mailing Address Ok t_ <br /> Lot# Block# Subd.Name r�4 # <br /> Z ! 1d 3� l Cs'v U <br /> Ci State Zip Code Phone Number ❑City /, <br /> N AJ r 6-1V 816 ❑Village 04/" NQ1 j Road <br /> New Construction Use: Residential/Numberof bedrooms Z- Code derived design flow rate Zg�bPD <br /> [;Replacement ❑Publ* o mercial—Describe: <br /> Parent material , �rr Flood Plan elevation if applicable ft. <br /> General comments and recommendations: <br /> Boring# ❑Boring �) <br /> Pit Ground surface elev. �7A. Depth to limiting factor17 J-7in. <br /> Soil Application Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/Fe <br /> In. Munsell Qu.Az.Cont.Color Gr.Sz.Sh. `Eff#1 `Eff#2 <br /> Boring# ❑Boring p <br /> Pit Ground surface elev.7(��o ft. Depth to limiting factor y Z in. <br /> Soil Application Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/Fiz <br /> In. Munsell Qu.Az.Cont.Color Gr.Sz.Sh. `Eff#1 I 'Eff#2 <br /> 7. _ /Z ZS X � G , 7 <br /> /•G <br /> Z '8zfie 6 Z , � <br /> rX <br /> 'Effluent#1 =BOD,>30 5 220 L and TSS>30 5150 moll- `Effluent#2=80D,>305 220 /L and TSS>30 5150 m <br /> CST Name(P e Pri��K�/v�� Signature � CST Number q6-141 <br /> S <br /> Address Date Evaluation Conducted Telephone Number <br /> SBD-8330(R04/15) <br />