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Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of <br /> Division of Safety and Buildings <br /> in accordance with Comm 85,Wis. Adm. Code <br /> Attach complete site plan on paper not less NCountyyan 8 1/2 x 11 inches in size.Plan must 3u,r n C 71' <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. 07-o$r{� -,�'(-/ -/,�.5 /5-944- 61'$o0 <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)). <br /> Property Owner '7 Property Location <br /> L)OS,1 ReGovt.Lot .5- 114 114 S // T ?7 N R /-S" E(000 <br /> Property Owner's Mailing Address Lot# Block# Subd.Name or CSM# <br /> d30A tyL ' woo GP LK /?�Q. / 7 V.bP308 9//707 <br /> city State Zip Code Phone Number ❑city ❑Village 2Tcwn Nearest Road <br /> r�FAN 1r.S.4", SN YYe i ( ) 7--Wf- <K jWh,4- Ane <br /> ® New Construction Use:® Residential/Number of bedrooms cf Code denved design flow rate 3oGPD <br /> ❑Replacement ❑ Public or commercial-Describe: <br /> Parent material /G-C i./ /-)�r'Fo Flood Plain elevation if applicable <br /> General comments (ev, 9w- 177 <br /> and recommendations: ISYS. H <br /> B J1 to exitr - Cre66 r 0 / - 0 L <br /> F-1-1Boring ❑ Boring <br /> # <br /> ® pit Ground surface elev. qy a R. Depth to limiting factor /g in. Soil Application Rate <br /> Horton Depth Dominant Calor Redox Description Texture Structure Consistence Boundary Rocts GPD/!P <br /> in. Munsell Cu.Sz. Ccnt.Calor Gr.Sz.Sh. I •-cf l 'Eff#2 <br /> / o -9 7,Syi73Id- — /s /ins,/e d/ cs 3rn . 7 /.l; <br /> Y- /O 7svrz 9/ 1 — /Fs ,t r .i,4/Z o! / G s 3co /. 6 <br /> 3�0 6 <br /> /8-a i. 7.Syr7 EyEsvQ r/Fs <br /> ® Baring# ❑ Boring <br /> ® Pit Ground surface elev. 4y O ft Depth to limiting factor&t in. <br /> Soil At;clicatlon Rate <br /> Horizon Depth Dominant Color Redcx Description Texture Structure Consistence Boundary Roots L GPD/ff <br /> in.. Munsell Qu.Sz. Cont.Calcr Gr.Sz Sh. •Eff#1 •Etf#2 <br /> -2 -w2`11 - //=S i rsl�/� o�l G S 3c'o .S- /• o <br /> 5;Z- e45A 65 3co 4 . 6 <br /> ,to-,1,8' 7.f'7/2 � cc>,c'SYi2% s.c/ �»,..6/c vrozC — d m •�? • (� <br /> 'EtBue it#1 =BOD >30<220 mg/L and TSS>30<150 mg/L 'Effluent#2=BOD <30 mglL and TSS 130 mrA <br /> CST Name (Please Print) Si natur <br /> James Number <br /> 5044nre/s S 73�,�0 <br /> Address Date Evaluation Conducted Telephone Number <br /> 77/oG l{c 3s G(/e b3 car wr S4�i3 /O — �� <br /> 7/.S-- P66- 4/5--7 <br />