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Wisconsin Department of Commerce SOIL EVALUATION REPORT Page Of 1 <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 dG <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. 0–,TY 7� <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)). Z lJ fKq rV3 <br /> Property Owner J Property Location G, [. �J <br /> JOA �/ e �'� /t13On1 Govt.Lot 1/4 1/4 S,,;,) 15?7N R E(o W <br /> Property Owner's Mailing Address Lot# Block# S Home or CSM# <br /> 8 .2 cle S� -- o 1/7 <br /> City State Zip Code Phone Number <br /> ❑City ❑Village ' own Nearest Road <br /> c ys!/ti <br /> ❑ New Construction Use: Residential/Number of bedrooms Code derived design flow rate ?py GPD <br /> Replacement /f ❑ Public Ior commercial-Describe: <br /> Parent material Flood Plain elevation if applicable ry q ft, <br /> General comments <br /> and recommendations: ,u� �s <br /> /Y0// A � >o � TOr j�/� �O�c/ /YG3dl6f/G l� 5ys�r <br /> F-1Boring# E] Boring <br /> ❑ Pit Ground surface elev. 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 /> F-1Boring# E] Boring <br /> ❑ Pit Ground surface elev. 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 I *Eff#2 <br /> *Effluent#1 =BODS>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 Print � r Signature CST Number <br /> Address/�r1Ll/ y C . G�/v Date Evaluation Co4e-le—phoneNumber nducted <br /> SBD-8330(1107/00) <br />