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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. Code <br /> Attach complete site plan on paper not less than 81/2 x 11 inches in size.Plan must <br /> aunty B rn 4 1`7F <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. 0d G_ 7d S-,Q 93 cz-o <br /> Please print all information. Revi Date <br /> Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). <br /> Property Owner Property Loption <br /> Reel e E//4s'd- Govt.Lot SW 1/4 A/1/4 S aX T 4/0 N R /6 E(or)W <br /> Property Owner's Mailing Address Lot# Block# Subd.Name or CSM# <br /> r,�3 99 Sic>.1e- G�tc RcQ <br /> City State Zip Code Phone Number ❑City ❑Village ®Town Nearest Road <br /> webs e.- ws I 61-111193 ( ?rr)86b- yJ�6 ooklaraf I Wa,s A A 5 fon Sf <br /> ❑ New Construction Use:®Residential/Number of bedrooms Code derived design flow rate 300 GPD <br /> ❑Replacement ❑ Public or commercial-Describe: <br /> Parent material G/ac i a (-r- Flood Plain elevation if applicable <br /> General comments <br /> and recommendations: <br /> © Boring# ❑ Boring <br /> Q pit Ground surface elev. ft. Depth to limiting factor > 8/ in. <br /> Soil flcation 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 'Eff#2 <br /> / <br /> 6-3 �,sw?-'/.L 1-ns-4k- k" 1 Gs 3 m .7 <br /> 1- d- sto >.rY,P k'4 — s mss .., ► G s .,. ,7 l,d( <br /> Boring# Boring <br /> ❑ pit Ground surface elev. ft. Depth to limiting factor in. <br /> Soil Application Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/1F <br /> in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. •Eff#1 'Eft#2 <br /> Effluent#1 =BOD >30<220 mg/L and TSS>30<150 mg/L 'Effluent#2=BOD <30 mg/L and TSS:5 30 mg/L <br /> CST Name(Please Print) Signatur CST Number <br /> rJa r»es S r /s .4 73*M <br /> Address Date Evaluation Conducted Telephone Number <br /> -77104 .�/w �r W als�tr t!/7— -jYf�S � to-�-'X-0� /�'-f1GG-�//S <br />