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Wisconsin Department of commerce SOIL EVALUATION REPORT Page_—of_ <br /> Division of Safety and Buildings <br /> in accordance with Comm 85,Wis. Adm. Code -- <br /> County <br /> Attach complete site plan on paper not less than 8 1/2 x 11 inches in size.Plan must s� <br /> include,but not limited to:vertical and horizontal reference point(BM),direction and pal 1, <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. 3 o -7 (� <br /> Please print all information. Re ewe by Date <br /> Personal information you provide may be used for secondary purposes(Privacy Lew,s.15.04(1)(m)). -S <br /> Property Owner Property Location _ <br /> /1 c O Govt.Lot 1/4 114V3 T YO N R/.7 E(or <br /> Property Owner's Mailing Address Lot# Block# Subd.Name or CSM# <br /> 77 <br /> 6l /6 r e-ti,� L•4 ti y t/ /S� <br /> city State Zip Code Phone Number ❑City ❑Village own Nearest Road <br /> ZY-/-h M5,T( ) -rhr k 5-0^.J j ' p, <br /> ❑ New Construction Use:%,,Residential/Number of bedrooms Code derived design flow rate ® _GPD <br /> IkRelacementcommercial <br /> p ❑ Public or / -Describe: <br /> Parent material A G//� f dr C-Ct- Flood Plain elevation if applicable <br /> General comments <br /> and recommendations: c / <br /> 67;U 0 4 5 `i /�-�� ,4 tJl�o r- 4ry Y 5-7 <br /> 5 y5 �, <br /> Boring# Boring <br /> pit Ground surface elev. !Aft. Depth to limiting factor —in. <br /> Soil Application Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDKII <br /> in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. `Eff#1 •Eff#2 <br /> 7'41,P �6 - S <br /> Boring# E] 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/fF <br /> in. Munsell Qu.Sz. Cont Color Gr.Sz.Sh. •Eff#1 'Eff#2 <br /> Effluent#1 =BOD >30:5 220 mg/L and TSS>30:E 150 mgA. •Effluent#2=BOD <30 mg/L and TSS 130 mg/L <br /> CST Name (Plepse,Print) Signature CST Number <br /> Date Evaluation Conducted Telephone Number <br />