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Wisconsin Department ofCommerce SOIL EVALUATION REPORT Page_ol_ <br /> Division of Safety and BUIIdNgs <br /> in accordance with Comm 85,Ws. Adm. Code <br /> ty <br /> Apach complete site plan vertical <br /> paper not less Man 812 x e int( in size.Plan must <br /> percent but not carMated to:vernal a.n horizontal reference paint(dist nce to <br /> are pyo l D o> 03.1 d 4//S ]/S0 3o" 0 00 <br /> percent slope.scale oreimensions.north snow,and location and distance to nearest roan. a/d 000 <br /> Please print all information. -5-F/3-//7 Reviewed by Date <br /> Personal informabon you provide may ee used for aeconaary pvmeses IPd.acyiaw,s.45M4(,)(in)) <br /> Property Owner Propery Local <br /> / /�9/r C C GoN.Lot 1/4- 1/4 S 7/ T /t( N R IS E(or)&0 <br /> PropeM Owne<s Mailing Aeeresa Lot# Block k Subd.Namw DSMp <br /> '/1. 69 Oalcd,,,le Awe / Le e 651, 1 - 170 <br /> City State Do Code Phone Number ❑City ❑Nllage OT. Nearest Road 6 45' <br /> W -ft o a-( N I SS//d ( ) f 'J1 I /»r r.ra uc /7.I. <br /> ❑ New Construction Use:[$Residential/Number of bedrooms S Code Cenved design flow rate Yf6 GPD <br /> ®Replacement ❑ Public or commercial-Describe: <br /> Parent material G/4c •. I �� : �� Flood Plain elevation if applicable N/F ft <br /> General commentsand rerotrvnen talions:. S yJ e ri 0 <br /> Oduring# ❑ Bann, <br /> Ej pit Ground surface elev. 4f• h. Depth to limiting factor > 8S in. <br /> Srl 'ptgn Rate <br /> Hot¢on Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIIP <br /> in. Munsell Ca.Sz. Cont Color Gr.Sz Sh. 'EH#1 'Eff#2 <br /> /SSG" a...r6K <br /> 3c.Sv 7- 9R�Iy /FJ/! .1 .S4le / G r l.y . S /. a <br /> Boning# ❑ Boring <br /> ® Pit Groundsudaceelev. 9S-g n. Depth to limNnghMr 7 8G in.. Soil Application Rate <br /> Haman Depth Dominant Color Redox Description Texture Saul Consistence Boundary Roots GPD <br /> in. Munsell W.Sr. Cont.Calor Gr.St.Sh. �I �' /fF <br /> 'Ef#1 'EM <br /> cC _ J9 7. m '4 le .-r../ 4S Yce . 7 A6 <br /> 036 /,,., / GS dc•• , -7 <br /> y-9G 7S 5 R%4 S QS F iss / — . 7 /. G <br /> 'EMuent#1 =BOD,>30<220 mgL and!TSS 130<150 mg/L •Effluent#2=BOO,<30 mWL and TSS 30 mgL <br /> CST Name(Please Print) SignaNre ^ (•gr Nor <br /> limes Sl�anre/S S ,✓G..-✓� 7340 <br /> Adtlress Date Evaluation Conducted Telephone Number <br /> } 776p y,-, 35— G(Jeb3 f.^� sur S489J <br /> 16 -Js= /3 lis- 966- 4/S7 <br />