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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 $u r H,e7t <br /> Attach complete site plan on paper not less than 81/2 x 11 inches in size.Plan must <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. 01d. 30 0 <br /> Please print all information. Reviewed by Date <br /> Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). <br /> Property Owner Property Location <br /> (vn S70-4 S 17 k Govt.Lot 1/4 1/4 S S T N R /S E(or)® <br /> Property Owner's Mailing Address Lot# Block# I Subd.Name or CSM# <br /> / 6/,7 ILI.'k Ail <br /> city State Zip Code Phone Number ❑city ❑Village [Town Nearest Road <br /> UJAlfe d�a, I P"A' I S5-40 I (bs/ ) X39-d l7/ '-'kG/l.Sen 1 G/fav k <br /> [2 New Construction Use: Residential/Number of bedrooms Pl--,v,v Code derived design Row rate GPD <br /> ❑Replacement ❑ Public or commercial-Describe: <br /> Parent material /w!a- rte✓%rr Flood Plain elevation if applicable <br /> General comments <br /> and recommendations: <br /> F-71Boring# <br /> ® Boring <br /> E] pit Ground surface elev. 9.SO ft, Depth to limiting factor -7V in. Soil Application Rate <br /> Horizon Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Roots GPD/fF <br /> in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'ER#1I 'Eff#2 <br /> c-if 7.SYR - i .5 1 .-71 1 .6 <br /> 4/4 • 7 1-'e'- <br /> 't <br /> 6't 6- 7/ <br /> Boring# ❑ Boring <br /> ❑ Pit Ground surface elev. R. Depth to limiting factor in. soil lication 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. 'ER#1 'Eff#2 <br /> Effluent#1 =BOD >30:5 220 mg/L and TSS>30<150 ng/L 'Effluent#2=BOD <30 rtxyL and TSS_<30 mg/L <br /> CST Name(Please Print) Signature CST Number <br /> Ja eu -S. 00n1e/5 1 73e/046 <br /> Address Date Evaluabon Conducted Telephone Number <br /> 0.7760 //H. 3S rr�e�s>�r C.v1 sw��3 0,�ly-o 7iS-866-�iis7,�, ,M . <br />