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ORIGINAL <br /> Wisconsin Department of Commerce SOIL EVALUATION REPORT <br /> Division of Safety and Buildings Page I of`3 <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 <br /> indude,but not limited to:vertical and horizontal reference Point(BM),direction and Parcelv -03 <br /> Percentslope,scale or dimensions,north arrow,and location and distance to nearest road. I.D. O3 'f'z• 1'I '3,xb yp•3 0344r OIb2Dp <br /> Please print all information. Reviewed b 5�3� 0 <br /> y Date <br /> Personal infortnetion you Provide maybe used for seaorMary Purposes(privacy Law,s.15.09(1)(m)). <br /> Property Owner I(pIl <br /> Property Lnptiorl�-sE 5.33 -f- <br /> f<wt Weln Z1tr / G"Im,10 va <br /> Property Owner's Mailing Address $(r) 5(d1/a CCS T IV/ N R A#-/7E <br /> (or) <br /> Lot# Block# Subd.Name or—CSW <br /> _R <br /> -Y) .f <br /> Cay State Zip Code Phone Number <br /> $eM crow t- car ❑City ❑Vllage ®Town nearest Road <br /> s'r10a�' ((„rl )147 dG 0 .Sr••r11 C./ertcAta.a h'.! <br /> ® New Construction Use:[a Residential/Number of bedrooms A Code derived design flow rate 00 <br /> ❑Replacement <br /> ❑ Public or commercial-Describe: GPD <br /> Parent material /A"& rocy <br /> General comments Flood Plain elevation if applicable <br /> andrecommendations: sys• e/eu c2k2•00 60 9e4 J <br /> Me�W.L as 399 g - �9q D (T'rey/l"9 Sa..d ,r�j•g a /00 c McNal+ a Sap(Boring# Boring <br /> © Pit Ground surface elev. O 8. Depth to limiting factor 7 7-9 in, <br /> WDoMmi,nr Redox Description re . StructureConsistence Bouin.Qu.Sz. Cont.Cola �' Roots GPD/ffGr.Sz Sh. •Eff#1 •Eft#2 <br /> J b"ib/< <br /> — s epsa r+/ — <br /> ' <br /> Boring# ❑ Boring . <br /> ® Pit Ground surface elev. 9SS•99 ft. Depth to limiting factor > 7G in. <br /> Horizon Depth Dominant Color Redox Description Texture StSoil ficetion Rate <br /> in. P Structure Consistence Boundary Roots GPD/W <br /> Munsell Qu.Sz. Cont.Color <br /> Gr.Sz.Sh. •EfF#1 •ER#2 <br /> t. 74 7ryi7� <br /> • <br /> Effluent#1 =BOD >30_<220 rig/L and TSS>30<150 nV& •Effluent iX2=BOD c <br /> CST Name(Please Print) _30 mglL and TSS c 30 rtglL <br /> Signature Nurrrber <br /> JGMes s /�n,e/S ,��.....�7 csT <br /> Address 73410 <br /> ,14 7760 Date Evaluation Conducted <br /> Telephone Number <br /> Gt�ebsf� cars43 /o- a- / o <br /> — 7is-- X66- 4iS7 <br />