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i 'jl I <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 rReviewed <br /> Attach cgmplete site plan on paper not less than a 1/2 x 11 'riches in size.Plan must e^r'lr -e, <br /> t 4Ut Pot ligyted to:vertical and horizontal reference point(610),direction anUa7„0percent slope,stale Or dimensions,north arrow,and location and distance to nearest road. -� �3�-/5=- 0000 <br /> Please print all information. byDatePersonal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(1))Property Owner � 1 / Prope yLocation <br /> O� 6%r e, 5 tr.,J Govt.Lot S 1/4 1/4 S 4V T 3S N R EI or)(0 <br /> Property Owner's Mailing Address ol# Block L # Subd.Name or CSM# <br /> 8 or ` /e /_A) q — <br /> City State Zip Code Phone Number ❑City g Village }Town Nearest Road <br /> n1 sS �7 ( ) �,4�o//e�j`� ays3j� <br /> ❑ New Construction Use:QF-Residential I Number of bedrooms__-w.7. Code derived design flow rate (1-6 '--� <br /> lacemenl g ---3-_-- GPD <br /> P ❑ Public or commercial•Describe: <br /> Parent malarial_�_/ ,C- _ t)---j<-Y_ Flood Plain elevation if applicable J _ ft, <br /> General comments <br /> and recommendations: <br /> „ , ��lionls�fe c, ca ..� �Py - vcyh�( B�1 <br /> NkdQ w as ILY718 - Gat Golfs' -denah a / <br /> Boring# ❑ Boring <br /> Ground surfs _ <br /> ce elev. q 7 <br /> IIf /l��II Pi _1_-.9 n ft. Depth t limiting C/ <br /> LJ•-.� ® 1 4U-- P o g factor___,?�_in. <br /> _ <br /> Soil Application Rate <br /> r 'HonY�'n' ptt ' bminant Color Redox Description Texture Structure Consistence Boundary Roots GPD/(f' <br /> Munsell Qu.Sz. Cont. Color Gr. Sz.Sh. <br /> in. . 'Eff#1 'Eff#2 <br /> / o ,,Pa / rn fid JFi �s ,,6 <br /> S - <br /> 3 f- k%G — / Ko <br /> Boring <br /> 2 Boring# �j /� <br /> F_ <br /> [) Pit Ground surface elev. It. Depth to limiting factor-->717- In. <br /> Soil Application Rale <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft? <br /> In. Munsell Qu.Sz. Cont.Color Gr.Sz. Sh, 'Eff#1 'Eff#2 <br /> ' <br /> Effluent#1 =BOD >30_220 mg/L and TSS>30< 150 mg/L 'Effluent#2=BOD,:S 30 mgfL and TSS<30 mg/L <br /> csT r4o.... (ateu.e gam> Signature CST Number <br /> Ti ale llwhna <br /> Signature CST Zz76 9/ --- <br /> Address Date Evaluation Conducted Telephone Number <br /> ox -5-/ (/ _ r) cit S4/P7-2- 30 -/D <br />