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Wisconsin Department of Commerce <br /> Division of Safety and Buildings SOIL EVALUATION <br /> REPORT <br /> in accordance with Comm 85,Wis. Adm. Code <br /> Attach co page �of <br /> complete site plan on paper not less than 8 1/2 x 11 inches in <br /> include,but not limited to:vertical and horizontal reference County <br /> Percent slope, size.Plan must <br /> P scale or dimensions,norm arrow. Point(dist direction and <br /> and location and distance to nearest road. Parcel I' <br /> Please print all information. <br /> Personal Infonnallon you Provide may be used for secontla <br /> Reviewed by <br /> P'oPertyOwner ry Purposes(Pnvacy Law,s.15.04(1)(m)). Date <br /> MA Mq6R Property Location <br /> ProPertyoO Owners Mailin Address Govt.Lot <br /> 11 coq � n 7/a 7/a s2$ T 41 N R <br /> Ci lJ✓N ,��, S _ Lot# Block# Sul Name or CSM# r� E(or LV <br /> / Stat [Z'ipp CCodep Phone Number W.Q� <br /> �'�H✓G1b�1 X438 ❑City N11� 7 .�C <br /> ( ) ❑Village Town Near�t Road <br /> New Construction �W 1SS <br /> Use:�Residential/Number of bedrooms V <br /> ❑Replacement — — Code derived design flow rate <br /> ❑ Public or commercial-Describe: O <br /> Parent material ter f A/t �, — — GPC <br /> General comments -t�-� —JL��1�� FIS plain elevation if applicable <br /> and recommendations: <br /> Sys . E•L . 99.0 <br /> ElBoring# ❑ Boring <br /> Pit Grouidsurface elev. <br /> _ 7 / <br /> HorizonDem ft. Depth to limiting factor 1 Z <br /> P Dominant Color Redox Description —In. <br /> in Munsell' Texture Structure Consistence Bounda Soil A lication Rate <br /> ' Qu.Sz. Cont.Color Boundary Roots <br /> Gr.Sz.Sh. GPD/ff <br /> Z b- IZ s Zillabk Ally Eff s � Ef#2 <br /> 3 Z-36 5 4... ,fid s �r s l l�abk <br /> Scf cabk 2c" . 4 1 . 4 <br /> Zco . T <br /> . 3 <br /> I <br /> I <br /> ! Z( <br /> Boring# 1_Z Boring (J <br /> - I U Pit Ground surfaceelev._I�,� <br /> Horizon ft' Depth to limiting factor 2 <br /> Depth Dominant Color Redox Description in. <br /> In. Munsell Texture Structure' Consistence Boundary Soil lication Rate <br /> ry Roots 0.. 7 7-S n 3 2 Cu.Sz. Cont.Color Gr.Sz.Sh. GPD/fF <br /> 2 . 12 5 rt 4 4 61 •Eff#1 •Eff#2 <br /> 3 12-z9 R y Q C31 <br /> els nS g SSI <br /> Effluent#1 =BOD >30<220 mg/L and TSS>30< 750 mg/L <br /> CST Na (please Print - <br /> Effluent#2=BOD 30 mg/L and TSS<30 mg/L <br /> Si nature - <br /> Addre f CST Number <br /> 27760 S Date Evaluation Conducted _�7�osl <br /> Telephone Number <br /> (Ji 7/s Sri- 41s7 <br />