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ORIGINAL <br /> Wisconsin oepartment of commerce SOIL EVALUATION REPORT Page__of <br /> Didision of Safety and Buildings <br /> in accordance with Comm 85,Wis. Adm. Code <br /> County ,�11 <br /> Attach complete site plan on paper not less than 8 1/2 x 11 inches in size.Plan must ^rq')T <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 3Z^ /00-017 <br /> Please print all information. Reviewed by //1 Date <br /> Personal information you provide maybe used for secondary purposes(Privacy Law,s.15.04(1)(m)). <br /> Property Owner Property Location <br /> Govt Lot 1/4 1/4 S J4 T14 N R ✓ E(or W <br /> Properly Owner's Mailing Address Lot# Block# Subd.Namp�CSM# <br /> to <br /> City State Tip Code Ptlotle Number ❑City ❑Village IM Town Nearest Road <br /> n) W r 5'?01 (74 ) W i 3� L• <br /> JZ New Construction Use: Residential/Number of bedrooms 3 Code derived design flow rate �lSU GPD <br /> ❑Replacement //_ ❑ Public/or commercial-Describe: <br /> Parent material G is f tial Pdn-Et Flood Plain elevation if applicable N.11ii ft. <br /> General comments <br /> and recommendations: <br /> SA • q3 .5 <br /> FF] Boring# [pt] Boring <br /> l� Pit Ground surface elev. 6• oft. Depth to limiting factor in. <br /> Sod Application Rate <br /> Horizon I Depth I Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF <br /> in. Munsell Qu.Sz. Cont.Calor Gr.Sz.Sh. •Eff#1 'Eff#2 <br /> 0-6 7,67 -Z — L 5 0 142- 65 IF . t. <br /> z -zs s Qy-YA 1 0 VF <br /> If <br /> 3 26--VA f YK9-6 a A se, M b 2 11 VP <br /> 7,?9,5--J �� <br /> a Boring# E] Boring / <br /> Pit Ground surface elev. C1 to b ft. Depth to limiting factor 78 in. <br /> Soil Application Rate <br /> Horizon Depth I Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF <br /> In. Munsell Ou.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 'Eff#2 <br /> ! 0-5 75 Z —�- GS oM m7 /•Z <br /> I1 G F 7 Z <br /> 3 - - -�— l L 5 1 U <br /> Effluent#1 =BOD >30:5 220 mg/L and TSS>30:5 150 mg/L •Effluent#2=BOD,:5 30 mg&and TSS<30 mg/L <br /> CST (Please print) i nature CST Number <br /> M- r &k±2A 22SSSl <br /> AddreA Date Evaluation Conducted Telephone Number t <br /> 27760 _S:5� � W 16 &6-4+S7 <br />