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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 ja i-N <br /> Attach complete site plan on paper not less than 8 1/2 x 11 inches in size.Plan must <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. 0/'91 O 700 <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 /> ProOwner Property Location <br /> yi5yle'o Govt.Lot 1/4 1/4 S 2S'T N R 6 E(or <br /> Property Owner's Mailing Addrefs / Lot# Block# Subd.Name or CSW <br /> P%7$ o� <br /> City // State Zip Code Phone Number ❑City ❑Village J&Town Nearest Road / <br /> �J I w2"6-YV-T I ( ).9 Y9.5-933 ^v-'- e A..)C^-) Pi e <br /> ❑ New Construction Use:C%Residential/Number of bedrooms aZ _ Code derived design flow rate 30 O _ GPD <br /> P,Replacement ❑ Public or commercial-Describe: ---- <br /> Parent material �i4 C�ri4( ��`i ��._ Flood Plain elevation if applicable `[ 1* ft. <br /> Lid J <br /> General continents 0-3'7 Ton <br /> and recommendations: Sem 4a <br /> • �pe�t ca <br /> 576:11111 gate . <br /> Boring# <br /> Boring <br /> l5� Pit Ground surface elev. /V/J_ft. Depth to limiting factor_�>/a _in. <br /> Soil Application Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Knots GPDM <br /> in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 'Eff#2 <br /> 0-6 7,59.3 — 7S m -A&, ., LV 4P- <br /> 7, <br /> ,s % — is ecooL_ <br /> Pit J Boring# C.Boring ri <br /> Ground surface elev. ft. Depth to limiting factor 70 d in. <br /> I C; mil ication 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 /> ,42 -?, 246La246L <br /> Effluent#1 =BOD >30 1220 mg/L and TSS>30:S 150 mg/L 'Effluent#2=BOD <30 mg/L and TSS 130 mg(L <br /> CST Name (Please Print) Signature Num <br /> ��. 2 <br /> Address Dat6 Evaluation Conducted Telephone Number <br /> 0c) �Yq-7a 6 <br />