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Wisconsin Department of Commerce SOIL EVALUATION REPORT Pagel of Ll, <br /> Division of Safety and Buildings <br /> in accordance with Comm 95,Wis. Adm. Code <br /> guptJL_ <br /> Attach complete site plan on paper not less Than B 1/2 x 11 Inches in size.Plan must County <br /> Indude,but not limited to:vertical and horizontal reference point IBM),direction and Parcel I.D. <br /> percent slope.scale or dimensions,north arrow,and location and distance to nearest road. <br /> Please prinf all Information. Reviewed b Date <br /> Personal mimmation you provide may be ueod rut secondary purposes(Privacy Law,s.15 04(1)(m)). <br /> Property Owner Property Location G✓ D <br /> f'/-6r.> 7' 4D�-ko /q v(DASC-- Govt.Lot ,3 1/4 114 SZC-/ T L40 N R /7 E(or <br /> P rty Owner's Mailing Address Lot" Block" Subd. Name CSM" <br /> 8soo a C� 2 )� U — <br /> CRy State Zip Cafe Phone Number ❑City ❑Village gTown Nearest Road 95co <br /> bAA)&)Pq IWt VA)10'/0 C'7 61 XIJ cJ <br /> Naw Construction Use:❑(�Residential/Number of bedrooms Code derived design now rale_-------- GPD <br /> C]Replacement 01 Public or commercial-Describe: _�"� �eLO�________ <br /> Parent material �C/f O.!I¢L }� 1(�� Flood Plain elevation If applicable <br /> General comments _ —_--_--_-- <br /> and recommendations: OLS-( �j�2�(Z Pl2 l V Y f pfd ��q/ZL S t�olZG SG+�o O(� <br /> aW 31,?6A- dsmi-Ut /ean ra.al <br /> ❑ Boring" 16l Boring , i1 rr <br /> ❑ pg Ground surface elev. ci'�fl. Depth to limiting fads_2 -In. <br /> Soil Applicalican Rate <br /> Horizon Depth Dominant Cola Redox Description Texture Structure Consistence Boundary Roots GPD/ff <br /> In. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'EO"1 'EB"2 <br /> 0- 6" 75,j 12 3 7 /, -L- <br /> (o- 7Z' <br /> Cn- 7Z` 7,Swlz %/f 7 1 , 7— <br /> F-1Bodno" F1 El <br /> ❑ Pp Ground surface elev. %. Depth to limiting factor in. <br /> Soil A liption Rate <br /> Horizon Depth Dominant Color Redox Description Texture Stnlchaa Consistence Boundary Roots GPD/f? <br /> In. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. •E""1 'ER"2 <br /> Effluent"1 =BOD >30<22011VIL and TSS>30< 150 mg/L 'Effluent"2=BOU <30 mg/L and TSS < 30 mWL <br /> CST Name (Please Print) - - Signalur CST Number <br /> on�A L !�✓�DrGG T -'-�_2, 66, 70 <br /> Address Data Evaluation Conl 1 J Talophone Number <br /> 1� 7i3 s, S%AiE/zn 3S DAwf3�� � j SY? 30 6/3U�o�j 7iSl�i�f3Svj <br />