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Wisconsin Department of Commerce SOIL EVALUATION REFI(JR I G I N A L <br /> 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 <br /> include,but not limited to:vertical and horizontal reference point(BM),direction and Parcel I.D. G/7t^ 932 5 -0 9 -;;kO U <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. 0p <br /> Please print all information. Reviewed bye <br /> Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(l)(m)). S/q 0 <br /> Property Owner Property Location <br /> (/^J Ff- / Govt.Lot 1/4 1/4 S T� N R S �W <br /> g Addre <br /> Property Owner's Mailins Lo # Block# Subd.Name or M# <br /> City State Zip Code Phone Number ❑City ❑Village JX Town Nearest Ron <br /> New Construction Use: Residential/Number of bedrooms Code derived design flow rate GPD <br /> ❑Replacement �❑ Pu ' or co rcial-Describe: <br /> Parent material AFlood Plain elevationifapplicable <br /> General comments <br /> and recommendations: <br /> F—/] Boring# ❑ Boring <br /> pit Ground surface elev. ft. Depth to limiting factor ZC _in. Soil Application Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fit' <br /> in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. *Eff#1 *Eff#2 <br /> 0-3 7 - i <br /> yaZt� �f� i <br /> 47 — , <br /> ® Boring# ❑ Boring c <br /> Pit Ground surface elev.97, ft. Depth to limiting factor_ z in. <br /> Soil Application Rate <br /> Horizon Depth jDoAminantColor Redox Description Texture Structure Consistence Boundary Roots GPD/ftz <br /> in. Qu.Sz. Cont.Color Gr.Sz. Sh. *Eff#1 Eff#2 <br /> G ✓► <br /> e y7 <br /> D — 7 42, <br /> *Effluent#1 =BOD5>30<220 mg/L and TSS>30<150 mg/L Effluent#2=BOD5<30 mg/L and TSS<30 mg/L <br /> CST Name(Please Print) KEN SCHMITZ, INCSignature CST Number <br /> Se tic S stems ` <br /> 2� <br /> Address Date valualion5olducted Telephone Number <br /> P.O. BOX 160 <br /> SHELL LAKE,W154871 <br /> 46 <br /> SBD-8330(R07/00) <br />