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WiisconsinDepartment OfCommerce SOIL EVALUATION REPORT IL� <br /> Division of Safety and Buildings _L_ <br /> in accordance with Comm 85,Wis. Adm. Code Page / of -L— <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 JVYJ t <br /> Percent slope,scale or dimensions,north arrow,and location and distance to nearest road. Parcel <br /> I.D. <br /> Please Print all information. Reviewed by <br /> Personal information ou Dat@ <br /> Y Provide may bs used for seeondaN Purposaa(Pmxy Law,s.15.04(1)(m)l• <br /> Property Ownerrip Property Location <br /> eal Govt Lot 1/4 1/4 S�} T N R 1,� E - <br /> Property Owner s Mailing Address Lot# Blodt# Subd Name or CSM# <br /> 55]!' omgazSer LJ- N 1it;,24 -7-55'1 3 <br /> �h State 27p.Code a Phone Numtxr ❑ ❑village Town <br /> v6►� RSET' _ Wi Sd-OZS ( - 14-7-2-449 SC077'- Nearest Road <br /> M�KE✓zi�- <br /> sy N@''v Construction Use: Residential/Numb of bedrooms 3 <br /> Code derived design flow rate GPD <br /> ❑Replacement A (3 Public or commercial-Describe: <br /> 4 <br /> Parent material LAc 14L DRi Flood Plain elevation if applicable N!A <br /> General comments ft. <br /> and recommendations: <br /> 7/s AL . /oo.z <br /> aung# ❑ Boring Q <br /> ® Pit Ground surface elev.�O�ft. Depth to limiting factor in. <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence BoundaryRoots Sod I�rD/fF Rata <br /> in. Munsell Ou.Sz. Cont Color GPD/fF <br /> ! Gr.Sz.Sh. ,Eff#1 -Eff#2 <br /> D 5 3 M Q; <br /> jr <br /> i C <br /> ,s+v{r S S 9 <br /> 4 4 "fsass G bk ti <br /> ZI, � ! Boring# Boring Q p tl <br /> III --- III ® Pit Ground surface elev. 1 0• I�/ ft. Depth to limiting factor �O n. <br /> Horizon' Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots Soil Application Rate <br /> n. Munsell Cu.Sz. Cont.Color Gr.Sz.Sh. ry GPD/fP <br /> I •Eff#1 'Eff#2 <br /> f <br /> M' Cs o f 7 Z <br /> 2 5 Sia s sc A-f/ cs /,µ 1-5 9 <br /> c a 6k <br /> i I i <br /> E8luent..v =BCD >30<220�.'L �rd'SS >30< 150 mg/L cf%ent-2=BOD <br /> C <30 mgl and TSS<30 mg/L <br /> ST NamP <br /> ( lease Print) Signa re <br /> (j/ i r CST Number <br /> i Acdress Z2_57$ <br /> r Date_raluabcn Conducted _ Telechone Number - i <br /> 277605 Gr�sjr , W'l. S9S /-2-p7- %ISCb 4+s7 i <br />