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Wisconsin Department of Commerce SOIL EVALUATION REPORT Page- <br /> of-Division of Safety and Buildings <br /> in accordance with Comm 85,Wis. Adm. Code p <br /> Attach complete site plan on paper not less than 812 x 11 inches in size.Plan must County t3 r+r n C?� <br /> include,but not limited to:vertical and horizontal reference point(BM),direction and Parcel LD, <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. <br /> Please print all information. Reviewed by Date <br /> Personal information you provide may be mad for secondary purposes(Privacy Law,s.15.04(1)(m)). <br /> Properly Owner Property Location <br /> p <br /> JeAn /L ISA4 ve-y GovL Lot 1/4 V4 S /O T yO N R 7S- E(or)® <br /> Property Owner's Mailing Address Lot# I Block# I Subd.Name or CSM# <br /> /s on V 60 <br /> City State Zip Code Phone Number ❑city ❑Village ❑Town Nearest Road <br /> 0W4..1ennet ji,0011 1 SS-060 1 (Sa7)390 -/3/4 sen I tna%t Md. <br /> ® New Construction Use:® Residential/Number of bedrooms—o— Code derived design(low rate 3a 0 GPD <br /> ❑Replacement ❑ Public or commercial-Describe: <br /> Parent material (i/Le rix 9*1" Flood Plain elevation if applicable NSA ft <br /> General comments S/s, e%✓ Yd• d <br /> and recommendations: <br /> F/ Boring# <br /> ❑ Boring <br /> ® pit Ground surface elev. 9s- 7 ft. Depth to limiting factor 1 804 in. <br /> Sal icetbnRate <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 I •Eff#2 <br /> O - ff 74",k %µ — /S /ers6/r rK l G 5 3r+ 7 /• � <br /> os";- .0/ LS 3ea '7 /. 6 <br /> Boring If ❑ Boring 9S.,I <br /> Pit Ground surface elev. ft. Depth to limiting factor > 7f in. FdI icabon Rate <br /> Horizon Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Roots GPD/fP <br /> In. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Etf#1 I 'Efi#2 <br /> Effluent#1 =BOD >30<220 mg!].and TSS>30<150 mg/L •Effluent#2=BOD <30 mglL and TSS:S 30 nlWL <br /> CST Name(Please Prim) _ _ Signature CST Number <br /> d.n is.t S ✓)4t /e/s S��,,. 73r 41,1 v <br /> Address V Date Evaluation Conducted Telephone Number <br /> 77,6 0 11—y 3S wedslr�- fuZ J. 9" 6-/0 - 06 -71J-- 866- IVI - 7 <br />