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Wisconsin Department of Commerce SOIL EVALUATION REPORT Page l of <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 8 1/2 x 11 inches in size.Plan must County / <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. <br /> Please print all information. Reviewe y Date <br /> Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). /4,1CY'p3 <br /> Property Owner Property Location <br /> G-fJ A tiJ S O ti Govt.Lot NL 1/4/) 1/4 S/y T3 N R / / E(or)§ <br /> Property Owner's Mailing Address Lot# Block# SUm". eme or CSM# <br /> City State Zip Code Phone Number ❑City �} ❑Village aTo n Nea est Road <br /> c>c.k LAK <br /> ew Construction Use:ZY -Residential/Number of bedrooms Code derived design flow rate _j o�`) GPD <br /> ❑Replacement ❑ Public or commercial-Describe: <br /> Parent material 1'/q C ;/} / �7l; Flood Plain elevation if applicable /'C'`14 ft. <br /> General comments <br /> and recommendations: <br /> Boring# E] Boring // <br /> Pit Ground surface elev. b' ft. Depth to limiting factor J in. <br /> Soil Application Rate <br /> HorizonDepth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz <br /> in. Munsell Qu.Sz. Cont.Color Gr.Sz. Sh. *Eff#1 *Eff#2 <br /> 17 <br /> G� � <br /> Q �r <br /> FF Boring# ❑ Boring 7 C <br /> K Pit Ground surface elev. 7/ ft. Depth to limiting factor in. <br /> Soil Application Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 <br /> in. Munsell Qu. Sz. Cont. Color Gr.Sz.Sh. *Eff#1 *Eff#2 <br /> 2-3 R K <br /> *Effluent#1 =BOD5>30<220 mg/L and TSS>30_<150 mg/L *Effluent#2=BODS<30 mg/L and TSS<30 mg/L <br /> CST Name(Please Pri t) Signal a CST Number <br /> �J/14 . w .-22 7E S <br /> Address Date Evaluation Conducted Telephone Number <br /> C>Cr1, 3/y Sr�r �% �w%� s`Y7> <br /> SBD-8330(R07/00) <br />