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i <br /> Wisconsin Department of Commerce SOIL EVALUATION REPORT Page�_of <br /> Division of Safety and Buildings <br /> in accordance with Comm 85,Wis. Adm. Code <br /> Canty <br /> Attach complete site plan on paper not less than 8 1/2 x 11 inches in size.Plan must Qc.r n <br /> Include,but not limited to:vertical and horizontal reference point(BM),direction and Parcel I.D. <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. U 3(p qo 7.S o O 6 o o <br /> Please print all information. Reviewed by Date <br /> Personal informstion you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). <br /> Property Re, <br /> Property Location <br /> /�e, Z o e S 7' GovL Lot s W 114 N►r1/4 S 3 6 T tied? N R /7 E(or <br /> Property Owner's Mailing Address Lot# Block# Sutxi.Name or CSlYW <br /> e r /4 e- <br /> city State Zip Code Phone Number ❑City ❑Village [3Town Nearest Road P4t-r0 <br /> St• �a u j rrrN ssios ((osl ) logo-3579 un row <br /> © New Construction Use: Residential!Number of bedrooms +� Code derived design flow rate �� GPD <br /> ®Replacement ❑ Public or commercial-Describe: <br /> Parent material f lo-c ra 1 Q, %7"i` Flood Plain elevation if applicable A iL <br /> General comments <br /> and recommendations: syl. 42/e✓ 93 -&tl g5..15) <br /> M4PPW t}s <5*y(A Ll A- "A14 6 A 60vPL6X. <br /> ea;ng# <br /> a Boring <br /> � <br /> pit Ground surface elev. '7-7, 6 ft. Depth to limiting factor / 'D in. <br /> Soil 'cation Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF <br /> in. Munse Cu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 'Eff#2 <br /> / o-3 75-rR �7� — /S A-,56K S 3F .7 16 <br /> 3-`/.J 7 5'Y/? yeti slGr o sG y.r 1 G S ®l•+r -7 /. 6 <br /> 3 7.54/7 <br /> ® Boring# Boring <br /> © Pit Ground surface elev. 9 7'of ft. Depth to limiting factor �" in. Soil Application Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundaq, Roots GPDM <br /> in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eft#1 'Eff#2 <br /> O( 3- ,A 7. S yI?'1�y /J�Lr p1�++S�k ✓r� � GS 3 GO <br /> 76 7s y %y s e s6 ,� — -7 46 <br /> Effluent#1=BOD >30<220 mg(L and TSS>30<150 mg/L 'Effluent#2=BOD <30 mg L and TSS<30 mg/L <br /> CST Name(Please Print) Signature CST Number <br /> .Jac„'es S• Jet n l r°/1 S� 7-3`�+�62 <br /> Address Date Evaluation Conducted Telephone Number <br /> 776�i 9-a 77�s-86G-y/s"7 <br />