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Wisconsin Department of commerce SOIL EVALUATION REPORT Page of 3 <br /> Division of Safety and Buildings <br /> in accordance with Comm 85,Wis. Adm. Code County <br /> Attach complete site plan on paper not less than 8 112 x 11 inches in size.Plan must <br /> 6.1 <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. <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 Property Location <br /> San cl La/<e oGovt Lot 1/4 1/4 S .y T 3g N R /S"E(0061 <br /> Property Owner's Mailing Address Lot# I Block# Subd.Name or CSM# <br /> Al 7d coo 910.5e 3 <br /> City State Zip Code Phone Number ❑City []Village Town Nearest Road <br /> ECkmdarY 1wr ISV727 (7/S)874-5/79 La FL1,arre i Nor 70 <br /> ❑ New Construction Use:® Residential/Number of bedrooms_ �/ _ Code derived design flow rate_ r!s'O GPD <br /> ❑Replacement ❑ Pudic or commercial-Describe: <br /> Parent material L /Ac/A Flood Plain elevation if applicable <br /> General commentsSys• B/,per uP�e✓• 91t•a �EO `t�.t) <br /> and recommendations: // <br /> I4 w•e-' 9!. y l to 9`x'•0 <br /> Boring# ❑ Boring 9.S <br /> ® pit Ground surface elev. ftDepth to limiting factor in. <br /> N,7 <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Rootsin. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh.O-3 7SrR31/h — /S /irsbK m l CS 3r3- tV 75'r/?y/4 — O rr-r / G s `}✓P <br /> N aro-so 7.SY/P '�,0 6S — . 7 A6 <br /> .7 1. 6 <br /> ® ung# ❑ Boring <br /> © Pit Ground surface elev. 9S. 3 ft. Depth to limiting factor in. <br /> Sal icetion Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/IF <br /> in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 I 'Eff#2 <br /> / o-S 7.srq -)/ -- /s r„5j 3P 7 16 <br /> of 3- 36 7.SYit "�q — 0 O m / 65 3✓F 17 1, 6 <br /> 3 36- YY SYR `�/v — s o H / G s 7 /. 6 <br /> . 7 1. 6 <br /> S 60-8`f 7 s-vR-�;f, — s o M l — — . 7 /.6 <br /> Effluent#1 =BOD >30<220 mg/L and TSS>30<150 ng/L 'Effluent#2=BOD <30 mg/L and TSS<30 mg/L <br /> CST Name(Please Print) Signature CST Number <br /> Jd m L'J 45 . OG n f-elr S Q a.-rwt of 7-?`aat D <br /> Address Date Evaluation Conducted Telephone Number <br /> .Z7760 3S wC'bsf>°✓ [/ d7-osS 71y,- <br /> 86G-4rs> <br />