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Wisconsin &R I G I N A L 3 <br /> sconsin Department of Commerce SOIL EVALUATION REPPage <br /> Division of Safety and Buildings 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 d (Ney-'s- <br /> include,but not limited to:vertical and horizontal reference point(BM),direction and Pam I.D. <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. <br /> Please print all information. Reviewed by Date <br /> Personal informelion you provide may be used for secondary purposes(Privacy Law,S.15.04(1)(m)), <br /> Property Owner Property Location / <br /> ' /1> ° GovL Lot SE 1/4 I�F 1/4 S3Z T /11 N R �yE(o W <br /> �6 <br /> Properly Owner's[Mailing Address Lot# Block# Subd.Name or CSM# <br /> 7-1 � '!�e •lip <br /> Uty State Zip Code Phone Number ❑City ❑Village ®Town Nearest Road <br /> opt >�e MN 163RMe I 1AW,%J7 0. F <br /> ® <br /> New Construction Use:® Residential/Number of bedrooms Z Code derived design flow rate ;74500 GPD <br /> ❑Replacement ❑ Public Q commercial-Describe: <br /> Parent material 6lRG�bL(' /X� f Flood Plain elevation if applicable ztl—l- ft. <br /> General comments �� Z;Z 95 7 <br /> and recommendations: <br /> 9y-5— <br /> © Boring# ® Boring 7 <br /> ❑ Pit Ground surface elev. 7 7 ft. Depth to limiting factor 7 G� in. <br /> Soil Application Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff <br /> in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 I 'Eff#2 <br /> o- z6Y,e3/z d5 <br /> 3 36-16 7.Sl� vr/� <br /> Boring# ® Boring p <br /> ❑ pit Ground surface elev. G 7 7 it. Depth to limiting factor G in. <br /> Soil Application Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff <br /> in. Munsell Ou.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 'Eff#2 <br /> 1 o-q 2sW3;/z �'_ G <br /> 2 Y-3'7 7r5r2 y �� 5 <br /> 3���a z 5 reqs <br /> Effluent#1 =BOD >30<220 mg/L and TSS>30<150 mg/L Efflue =BOD <30 mg(L and TSS<30 mg/L <br /> CST Name(Please Print) _ Sgnatu CST Number <br /> T l , 1?S'I <br /> Address Date Evaluation Conducted Telephone Number <br /> Z 77 �w eb �e� w, oy /D l�-® Z Z;5- - Yis7 <br />