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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,Wis. Adm. Code <br /> County <br /> Attach complete site plan on paper not less than 81/2 x 11 inches in size.Plan must a r e <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. 01A. g3v0 O t YOP� <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 %T T <br /> Ha//P L i p>/erf Govt.Lot 1/4 1/4 S /S T 40 N R/s-' E(or <br /> Property Owner's Mailing Address Lot# Block# I Subd.Name or CSM# <br /> ck O 7o //w y I <br /> City State Zip Code Phone Number ❑city ❑Village ®T Nearest Road <br /> fir. Croix F/�f W-7 S`/OJ# ( •71-C 48.3-13ot9 -JP4 e/C 5oh i Red r,c fere' <br /> ® New Construction Use:® Residential/Number of bedrooms 3 Code derived design flow rate 41sn' GPD <br /> ❑Replacement ❑ Public or commercial-Describe: <br /> Parent material G/0Z e. Flood Plain elevation if applicable /y1,4 ft. <br /> General comments S J @/e d• cr//ti'r 9S•o 90.o 6.n4o v. (W.74 117,00 <br /> and recommendations: /orvt yr/ to `/G,7 Ce* q5. <br /> a Boring# ❑ Boring <br /> ® Pit Ground surface elev. ft. Depth to limiting factor 76 in. <br /> Sal 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. 'Eff#1 'Eff#2 <br /> / o-Y 7SM..lA -- /S c Y-1/ cS Jm 7 A6 <br /> .l 9- " 7S1rf y/9 — /Fs o ,., I 6S •3cp S- /.O <br /> 3 <br /> )O-S-6 7s rr/7 /6 — /FS O p r / G 5 d 1 S (. O <br /> ® Boring# ❑ Boring <br /> ® Pit Ground surface elev. 7 7. 6 ft. Depth to limiting factor > 7)- in. <br /> Sal kation Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/IF <br /> in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. •Eff#1 'Eff#2 <br /> I o-y 7sriR4'L — 7f o wr / cs Sao 7 /•6 <br /> et Y-3o 7 s'v? % /FS a rh I GS Sco S /' 0 <br /> 3 ?0- So 7.S'*i/ `/'p <br /> �{ 5'0-7d 7.r s-/i %ti — /s s a ..rr r — ^- ,•s' /. o <br /> Effluent#1 =BOD >30:5 220 mg/L and TSS>30<150 mg/L 'Effluent#2=BOD,:E 30 mot and TSS:5 30 rg& <br /> CST Name(Please Print) Signature CST Number <br /> ')'#4M 5-S S. f QQ,y of 734vo <br /> Address Date Evaluation Conducted Telephone Number <br /> &A 7760 u/e bS>`e-r 1N F -5-Y P93 //- f 0 y >/S-8�6- 4'1.5-7 <br />