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Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of 3Division of Safety and Buildings <br /> in accordance with Comm 85•Wis. Adm. Code <br /> Attach complete site County Qor,r h <br /> p plan on paper not less than 8 112 z i t fiches in size.Plan must � <br /> include•but not limited to:vertical and horizontal reference point(8M)•direction and Parcel 1.0 <br /> percent slope,scale or dimensions•north arrow,and location and distance to nearest road. 0j),- 9j'0J- O/6�x <br /> Please print all information. Re vew Date <br /> Personal information you Provide may be used for secondary purpoaas(Privacy Law,a.15.04(1)(m)). <br /> i23 ,cy d3 <br /> p'+oPerh'Owner Property Location <br /> t!A u'^/is Govt.Lot AIF 114 NW 1!4 S / TSO NR /S E(orX9 <br /> PropeRy Owner's Mailing Address Lot# Blodt# Subd.Name a CSM# <br /> / l0 S. Ridlqe Sf• <br /> City State ZCf Code Phone Number ❑City ❑Village ©Town Nearest Road <br /> <�rou, IZN 1 146307 1 (A17 )663-3(oW) ,Jackson I Loon Gk /loQ <br /> I <br /> C] New Construction Use:® Residential/Number of bedrooms 1 Code derived design low rate 1-4-0 GPD <br /> K Replacement C3 Public or commercial-Describe: <br /> 1 <br /> Parent material Glac is nr• � Flood Plain elevation it applicable AII.Al ft I <br /> General cornments <br /> and recommendations: 5/5. el-ev. 9 <br /> Boring# ❑ Ing <br /> ❑ Pit Ground surface elev. g Sed fL Depth to limiting facto, '_7 in. <br /> Soil Application Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff <br /> in. Munsell Cu.Sz. Cont.Color Gr.Sz.Sh. •ErT#t I 00#2 <br /> 6-4 7.3- -/( I& /S /tMs6/c r. j1 Cs <br /> d, `1-6'7 7.-S' N? ti/y +ns Oso rv11 63 3F 7 <br /> 3 5-7-(000 7.s r-4 �/e Flt SYR s/fr ms GSt'r rw I GS — - 7 <br /> i <br /> Borina# ❑ Boring <br /> I I Lf Pit Ground surface elev. 9s. R. Depth to limiting factor S3 in. <br /> Sail Acclintion Rate I <br /> Horizon Depth Dominant Col Redox Description Texture Structure Consistence Boundary Roots GPD/ff i <br /> in. Munsell 0u.Sz Cont Color Gr.Sz.Sh. E#t -•g,•z2 <br /> o-v 7.sy.P �/ _... I /s /,y,sdk n. l I �5 ��• � - 7 !.� � <br /> 4t S-y,� 7 i A � r <br /> 3 C ji, sy/r % w s oSG w. I G 5 ,, d <br /> y SS's <br /> bd 7.SyR "/Y I iE s N'1 I m,Jc; G S I _J I-/ 6 <br /> L + <br /> I <br /> f <br /> ERluent#1 =800 >30 1220 mg/L and TSS>30<150 mgfL E9uent 92=800 <30 mg/L and TSS<30 mgtL <br /> CST Name (Pl—PAnn Signature - - <br /> rn <br /> p CST Number I <br /> JgYhE3 5. Qr)rvi6/S oa t lPh O.7 3 904 U' 1 <br /> Address Date Evaluation Conducted Telephone Number <br /> 47 A0 3 W �ti/e� W.• S` 3 -7-a)-0 3 (7/ti 966- y/57 <br />