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ORIGINAL <br /> ` Wisconsin Department of Commerce SOIL EVALUATION REPORT Page__of <br /> Division of Safety and Buildings <br /> in accordance with Comm 85,Wis. Adm. Code - <br /> ' County <br /> Attach complete site plan on paper not less than 8 1/2 x 11 inches in size.Plan must awam <br /> include,but not limited to:vertical and horizontal reference point(BM),direction and Parcel i, <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 /> C(1 Govt.Lot 1/4 1/4 S� T N R llij E(or)67-7 <br /> Properly er s pMailing Address Lot# Block# Subd. Name or CSM# <br /> City Z-1 St@t6 Zlp Code Phone Number ❑City ❑Village own Nee st Road <br /> ❑ New Construction Us0glResidoms ential/Number of bedro _ Code derived design flow rate_ GPD <br /> eplacement C1 Public or commercial-Describe: --- <br /> Parent material Flood Plain elevation if applicable ft. <br /> General comments <br /> and recommendations: <br /> LM MROA 0ALIX <br /> Boring <br /> M Boring# MM <br /> 1 V Pit Ground surface elev, u/' ft. Depth to limiting factor 5$ 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. '5#1 'Eff#2 <br /> I -4 I • 7 <br /> y S w S2 z <br /> 3 AOCS Z <br /> sW •F e — 7 z <br /> Boring# Boring — <br /> Pit Ground surface elev.��-� ft. Depth to limiting factor 7 n. 5;iiApplication 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. 'Eff#1 'Eff#2 <br /> i o-s Is s &A .-> >. L <br /> s r <br /> e .-1 <br /> -7 I. Z <br /> Effluent#1 =BOD >30 1220 mg/L and TSS>30<150 mg/L Effluent#2=BOD <30 mg/L and TSS<30 mg/L <br /> CST NarA(Please Print) Si nature CST Number <br /> Ae 2ZS$Si <br /> Addre Date Evaluation Conducted Telephone Number <br /> 27760 3S �SM2 Wt. 5 9� $- -tel 71S- $(6-44s7 <br />