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Wisconsin Department of Commerce SOIL EVALUATION REPORTO R 1 G I N A L <br /> Division of Safety and Buildings <br /> Page__of <br /> in accordance with Comm 85,Wis. Adm. Code -� <br /> Attach complete site plan on paper not less than 8 1/2 x 11 inches in size.Plan must County <br /> include,but not limited to:vertical and horizontal reference point(BM),direction and Parcel I.D.O <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. 3 a 33q 3 06 <br /> Please print all information. Reviewed t�/ Date <br /> Personal information you provide may be used for secondary purposes(Privacy Lew,a.15.04(1)(m)). (/!I <br /> Property Own-esr Property Location <br /> NJ it h o/ SOnJ Govt.Lot o2 1/4 1/4 S_? 7 y� N R>� E(or)� <br /> Property Owner's Mailing Address r� Lot# Block# Stud. Name a CSM# <br /> S�, <br /> i i ki <br /> City State Zip Code Phone Number ❑City ❑Village Town Nearest Road / <br /> S •P,�4 nl sros ( ) W• sw/ss AA Lk <br /> ❑ New Construction Use:0-Residential/Number of bedrooms C;2 — Code derived design flow rate .7490 GPD <br /> Replacement ❑ Public or commercial-Describe: <br /> Parent material_ �-' �14C �`/9� t QI^%f r" Flood Plain elevation if applicable / <br /> General comments JJ <br /> and recommendations:Co-VACk9 'acYA/4-AJ O/A /ee,G fGro9��.`„9i., �—f <br /> IC`e,04 c-&_ <br /> © Boring# Boring <br /> ® pit Ground surface elev. ft. Depth to limiting factor-272-L—in. <br /> 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. •Eff#1 I •Eff#2 <br /> us �. L <br /> s�3 7. / !S , <br /> ® Boring# ❑ Boring <br /> ® Pit Ground surface elev. • ft. Depth to limiting factor 77�_in. <br /> 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. 'Eff#1I 'Eff#2 <br /> Effluent#1 =BOD >30<220 rnglL and TSS>30<150 mg/L •Effluent#2=BOD,:5 30 mg/L and TSS<30 mg/L <br /> CST Name(Please Print) Signature POPCST Number <br /> A)Ar./�. ! rn oa� =-:117 746r9/ <br /> Address Date Evaluation Conducted Telephone Number <br />