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Wisconsin Deportment ofCommerce SOIL EVALUATION REPORT Page J_of 3 <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 size.Plan must County Sk r n eh- <br /> include, <br /> h-include,but rat limited to:vertical and horizontal reference point(BM),direction and Parcel LD. <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. <br /> Please print all information. Revi Date <br /> Personal infomuition you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). <br /> Property Owner // Property location <br /> 7-o m Nd cva lac Govt.Lot SF 1/44ME 1/4 S.Z(, T 416 N R /S' E(or& <br /> Properly Owner's Mailing Address Lot# Block# me SuW.Naor CSW&49`l /Srh St. P/ace Al IN <br /> c <br /> City State Zip Code Phone Number ❑City ❑Village ®Town Nearest Road <br /> Owle01, Ie IMX 739- 89/.S- JacEson Grern Trail <br /> Ef NewConstruction Use:®•Residential/Number of bedrooms Code derived design flow rate 0 GPD <br /> ❑Replacement ❑ Public or commercial-Describe: <br /> Parent material 46%c i a l D,-iyv Flood Plain elevation if applicable ft <br /> General combats SX.d• g/e✓, 9a <br /> and recommendations: <br /> Boring# ❑ Boring <br /> ® Pit Ground surface elev. Zr 6 ft. Depth to limiting factor > 7�4 in. <br /> Sal Application Rate <br /> Horizon Depth Dominant Color Redox Description Texaue Structure Consistence Boundary Roots GPDNF <br /> in. Munsell Ou.Sz. Cont Color Gr.Sm Sh. •Eff#1 I •Eff#2 <br /> 0-'Y 7..f-Y'd 3/� /S /.ns 6k c$ 3C0 <br /> Y- Llp 7-S-M �Yp — is 1� sbk sr 1 G S 3eO 7 A 'A <br /> 1.6- 35 s-m 4/4 S CJS'-- w I GS .111 m 7 / W <br /> LI ?s-yf 7.S7,? — 5/6r ode- / GS - .7 /,a( <br /> S- 'fP-7�L 7sf4 sie — s e--'r e- r ! as _ .7 <br /> ® Boring# ❑ Boring -r- 67 <br /> 1- <br /> ® Pit Ground surface elev. - 67 ft. Depth to limiting factor 777M. . <br /> Sal Application Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM <br /> in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. •Efi#1 I •Efi#2 <br /> l b- Zf 7.r111? i — IS /',1561. M cs 3ta .7 /.A <br /> eL zt- 3,t 7.5- 'r/?104i — If /,ns6A n / 6S 3 e • 7 A.), <br /> -So s r/? `/ — s o-Ir e�- Aw .7 A-4 <br /> Z11 s0.-77s�A% — s osw l c s - .7 /.aC <br /> • <br /> Effluent#1 =BOD >30:c 220 mg/L and TSS>30<150 mg/L •Effluent#2=BOD <30 mg1L and TSS 30 mg/L <br /> CST Name(Please Print) Signature CST Number <br /> J,4MEs S. Qanr e�S &2n±S oC73�Jt0 <br /> Address Date Evaluation Conducted Telephone Number <br /> 77to0 flw 3s wt5&-6, w1 sgr5j <br />