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Wisconsin Department of Commerce SOIL EVALUATI(I R i711IC L Page l of <br /> Division of Safety and Buildings <br /> In accordance with Comm 85,Wis. Adm. Code <br /> Attach completesite plan on paper not less than 8 1/2 x 11 Inches In size.Pian must County boQ N L -F- <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. l7 <br /> Please print all information. Reviewed by Date <br /> Penicnal infbrmd n you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). fi r1J,i <br /> Property.Owner '• Property Location _ 1 <br /> E k3\s W �� Govt.Lot NJE 1/4 NU(1/4 S aq T 141 N R I j[p E(oft <br /> Property Owner's Mailing Address j Lot# Blodc# Subd.Name or CSM# <br /> k Pox C141 v <br /> Ury State Zip Code Phone Number <br /> • ❑City ❑Village Town Nearest Road <br /> WL► - GJi sy893 ( rs) zo -ia �a SL.ut5!�Zl -TowC�Z <br /> New Construction Use:❑ Residential/Number of bedrooms ,e Code derived design flow rate_ �© GPD <br /> ❑Replacement ❑ Public or commercial-Describe: <br /> Parent material 4 ieA04-6- 7�21,G T Flood Plain elevation if applicable JQ-4 ((„ <br /> General comments <br /> and recommendations: <br /> Boring <br /> Boring# P g _ <br /> 1 Pit Ground surface elev. l0©'Oft Depthto Iimitin factor 702 In,, -ySoil Application Rate <br /> Horizon Depth Dominant Color Redox Description Texture _ Structure Consistence Boundary Roots GPDHN <br /> In. Munsell Qu.Sz. Cont�Color ( Gr.Sz.Sh. •Eff#1 •Eff#2 <br /> . . h. <br /> i 0-g 75-41C / L+S mG 6`S aWl 11 �, <br /> 1 <br /> uif <br /> 8011r1g# Boring <br /> Pit Ground surface elev. —!b fL Depth to limiting factor 7a In. <br /> Sal Appllcation Rate <br /> Horizon Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Roots GPD/ftz <br /> — in._ Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. •Eft#1 •Eff#2 <br /> -� 79�rLy <br /> All <br /> _. _ . .. <br /> Effluent#1 =BODs>30<220 mg1L and TSS>30_<150 mg/L •Effluent#2■.BOD,<30 mg/L and TSS<30 mg/L <br /> CST Name(Phase Print) SI <br /> Il D Ahq ID �( _ CST Number <br /> aal�7L•� <br /> Address Date Evaluation CondutW Telephone Number <br /> l� ?r 3 5 5/WZ 1QD r,Ji'- 83v z7a/ 715- Zto" 35oy <br />