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Wisconsin Department of Commerce SOIL EVALUATION REPORT Page1__or� <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 81/2 x 11 inches in sae.Plan must co"'y N e rry. <br /> include,but not limited to:vertical and horizontal reference point(BM),direction and Parcel I.D. 07."J"k- y/•/ <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. 16- 7.ri-0/to s eo <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)). I _6 t <br /> Property OwnerProperty Location <br /> ✓ k 4 N Q -%/w G o S e r+ Govt.Lot 1/4 1/4 S 3s- T 41/ N R /(� E(or)49 <br /> Property Owner's Mailing Address Lot# Bbdt# Subd.Name or CSM# <br /> (o 9 F/swd e. l7P/r.e SA )JSG--W5 R%VaVtEw PAO <br /> Gly State Zip Code Phone Number ❑City []Village ®Town Nearest Road (P 4.6-t' <br /> 00-411�r y wr /fo-70 I ( ) $&V4 A$ F/�r✓a e. (fir <br /> ❑ New Construction Use:® Residential/Number of bedrooms ,r Code derived design flow rate ,?O O GPD <br /> [jd Replacement ❑ Public or commercial-Describe: <br /> Parent material /i-Ib c t L 1 0,'6 Flood Plain elevation If applicable N//9 ft. <br /> General comments <br /> and recommendations: s pd- B/t 17A• co (9/.83 fP 9¢.00) <br /> Maekd as ss/oc : Pomfo - Frer„,sfa f- Fula. A 51ony, com lex <br /> Boring# ❑ Boring <br /> © Pit Ground surface elev. 4G' ft. Depth to limiting factor 86 in. Soil Application Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roos GPD/ffr <br /> In. Munsell Qu.Sz. Cont.Color "Gr.Sz.Sh. •Eff#1 •Eff#2 <br /> 0,- ,4 7•SYR 34 — /S /wrt6ft r.,/ G 6 3M .7 /- 6 <br /> 4- NA 7.SrfQ V/,�, S6/t , „ I G S 7 w , 7 /. L <br /> 4t 7-5-We VP s ms c r G a / F . 7 /- (e <br /> 4 Yp 96 �s-yR f7q s os s w+ f — - <br /> . 7 1, 6 <br /> Boring# G� Boring <br /> FE]1 Pit Ground surface elev. 9S d ft. Depth to limiting factor 7y in. <br /> Soil Application Ras <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roos GPD/ff <br /> in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. I 'Eff#1 •Eff#2 <br /> l <br /> 0- ,., 7 ryR'?/� /S /�s6 k A" / e-s 3 on 17 /. & <br /> d y /H 7 SVR */Y /t ,t.,s 6/r . I 4 S 3a s . -7 /, (o <br /> (4- Sy 7.SYR `/t/�z9 — s O S r+ I �S J M 7 1, 6 <br /> Effluent#1 =BOD >30<220 mg/L and TSS>30<150 mg/L •Effluent#2=BOD <30 <br /> rng/L and TSS<30 mg/L <br /> CST Name(Please Print) ignature CST Number <br /> je'mes 73z/do <br /> Address V Date Evaluation Conducted Telephone Number <br />