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Wisconsin Department of Commerce SOIL EVALUATION REPORT Page / of /I <br /> Division of Safety and Buildings <br /> in accordance with Comm 85,Wis. Adm. Code �'7 <br /> KI^M•C7� <br /> Attach complete site plan on paper not less than 8 1/2 z 11 inches County (J size. tan must _ <br /> iinclude,but not limited to:vertical and horizontal reference point(BM),direcction and parcel I.D. 0 7 0!8 t ?9 /6 0 7 <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. G _ po0 - 01 3000 <br /> Please print all information. Reviewed by Date <br /> Personal information you provide may Ce used for secondary purposes(Privacy Law,s.15.04(1)(m)). 7 - <br /> Property Owner Property Location <br /> GA 10r r1 P2'k"SCn Govt Lot 1/4 1/4 S 7 T 3rj N R /6 E(or <br /> Property Owner's Mailing Address Lot# Block# Subd.Name or CSM# <br /> SSI w• ColuWb14 1 t/- 2 f39 <br /> City State Zip Code Phone Number ❑City ❑Village ©Town Nearest Road 78x9 <br /> CG1, ewa tills Wl $y�d9 ( ) lYleenc� Ge ,ted FF <br /> ❑ New Construction Use:® Residential/Number of bedrooms—3— Code derived design flow rate 43o GPD <br /> Replacement ❑ Public or commercial-Describe: <br /> Parent material 6(Ae is Flood Plain elevation if applicable IV/IV R <br /> Genera(comments /a6 AA�wI <br /> and recommendation: sr-S. elev. / <br /> MaPP�,I 8s 4g7A : memo-^ y S <br /> F Boring# Boring <br /> © pit Ground surface elev. gy ft. Depth to limiting factor 31 in. <br /> Soil Application Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff <br /> in. Munsell Cu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 -Eff#2 <br /> 9 7.srt/Z 31A — /Y /. � 1 s 3 r, . 7 / 6 <br /> 11- 31 7-5-W?44 /FS ,l...rd/e " / <br /> 7SVe `v/y CAdS-9/? /FS )ms.A Ae 1 <br /> d Baring# ❑ Boring <br /> © pit Ground surface elev. 93. 8 ft. Depth to limiting factor d S in. <br /> Soil Aloplication Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' <br /> in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. •Etf#1 I 'Eff#2 <br /> / c - 4 7.$-y17 / — /-S /s.,s6/e r l cs 3ti , 7 A 6 <br /> Y- dY- 7S1/2 %y — /S of , ar6/c *in I 5 See . 7 /.6 <br /> 'Effluent#1 =BOD >30< <220 nupt and TSS>30 150 nxA •Effluent#2=BOD 30 rtxyL and TSS< _ <br /> — _ _ <30 mg/L <br /> CST Name (Please Print) Signature CST Number <br /> JGmes 5 (�anr�lS S � .� 734ap <br /> Address Date Evaluation Conducted Telephone Number <br /> � 7760ffcr 3s GC/eb3fr� Lv1 54893 7— �— l� 7/S- r466- 4/S7 <br />