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Wisconsin Department of Commerce SOIL EVALUATION REPORT <br /> Division of Safety and Buildings Page I Of Z <br /> In accordance with Corrsn 85,Wis. Adm. Code <br /> Attach complete site plan on paper not less than 81/2 x 11 Inches In size.Plan must County 4 r rU C-It <br /> Include,but not limited to:vertical aril horizontal reference point(BM),direction and <br /> Percent slope,scab or dimensions,north arrow,and location and distance to nearest road. Parcel I.D. <br /> - <br /> P/ease print all Information. Reviewed by <br /> Personal information ou Date <br /> Y prowde may los ossa for secondary puryosos(Privacy Law,s.15.04(1)(m)). <br /> PropertyOwner � k <br /> f Properly Location L <br /> ,_T4 A s.� -.-j Govt.Lot NW 1/4 /00/14 s l 3 T 3 9 N R / 7 E(or)PropeliyOwner'sMallinpAddress Lt Block# Subd.momewCSM# ( <br /> ,?5-2,0w 70 - - <br /> Csy " Stele ZIP Code PFone Number ❑ <br /> ��5��J� City Page �Fown Nearest Road <br /> ( ) TV?_'73o n1 e �S <br /> 70 <br /> ❑ New Construction Use:❑ Residential/Number of bedrooms — Code derived design flow rateRepIacement ❑ Public or commeroial-Describe: <br /> GPD <br /> Parent material Flood Plain elevation if applicable Ij 119 <br /> General comments ft. <br /> and recommendations: O C j C-!S e—. 0 /0 <br /> l�1 <br /> oaf aS M-2W ma; CwjS, g: 6. <br /> Boring# ®-Boring <br /> ❑ pit Ground surface elev. <br /> —9!2z 7 R. Depth to limiting factor.,, in. <br /> Horizon Depth Dominant Color Redox Desch tion Soil Application Rate <br /> IP Texture Structure Constance Boundary Roots GPD/R <br /> in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. `Elf#1 •Eff#2 <br /> C O ro 7r P3i S 7 <br /> a -� <br /> S <br /> F-1Boring# ❑ Boring <br /> ❑ Pit Ground surface elev. ft. Depth to limiting factor in. <br /> Soil Application Rete <br /> Horizon Depth Dominant Coke Redox Description Texture Structure Consistence Boundary Roots GPD/M <br /> In. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. •Eff#1 •Eft#2 <br /> 0-) <br /> BUR 4ETr C OUNTY <br /> Z <br /> MW— <br /> Effluent <br /> I EMuent#1 =BOD >30<220 mg/L and TSS>30<150 mg/L •Effluent#2=BOD 130 mg/L and TSS<30 mg/L <br /> CST N (Please Signature CST Number <br /> 71, F-:5,461s), 76 9 <br /> Address f Date Evaluation Conducted Telephone Number <br /> -5-y' 7-2 <br />