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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,Wit. Adm. Code County 12 <br /> � - <br /> Attach complete site plan on paper not less than 8 1/2 x 11 inches in size.Plan must <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. _ 3/3 — <br /> Reviewed by Date <br /> Please print all information. . <br /> Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). <br /> PropertyOwner Property Location <br /> Govt.Lot AIC- 1/4 54v 1/4 S 3 T 3 N R /V E(o® <br /> P rty Owne Mailing Address Lot# Block# FSubd.Name or CSW <br /> SS3 /1 <br /> City State Zip Code Phone Number ❑City L]Village Town Nearest Road <br /> ( f) 777— u K r� <br /> (�J New Construction Use: Residential/Number of bedrooms _- Code derived design flow rate SD _--GPD <br /> ❑Replacement g Public or commercial-Describe: -------------- — - <br /> Parent material fc . nwZ 422f1 k/ Flood Plain elevation if applicable ft. <br /> i <br /> General <br /> comments �riED �c�d 7- if is/- 7,«,s: ,�co <br /> T-2 100.0 <br /> /R� J;;'¢NA) Arr SITE <br /> Boring <br /> Boring# Pit Ground surface elev. /o y?off. Depth to limiting factor >/06 in. Soil Application Rate <br /> 17 7 <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots, GPDIff <br /> in. Munsell Ou.Sz. Cont.Color Gr.Sz.Sh. •Eff#1- 'Eff#2 <br /> A/ AVL <br /> Z — S 6Airr <br /> Boring# Boring <br /> Pit Ground surface elev.��,f�ft. Depth to limiting factor 2� in. 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. CE 'Eff#1 'Eff#2 <br /> G / <br /> z19,23 /&--a 2 L z Se <br /> r A G S <br /> Z. <br /> Effluent#1 =BOD >30<220 nxyL and TSS>30<150 mg/L 'E uent#2=BOD <W=11-and TSS<30 mg/L <br /> CST Name(Please Print) Si ature �— CST Number <br /> :Add 1 Perk es ng Date E aluation Conducted Telephone Number <br /> 28288 McKenzie Rd. 7/SG-C> C?F <br /> Spooner, WI 54801 ana '�S/- vo_2- aiod <br />