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wsconsmDepartmentofCommerce SOIL EVALUATION REPORT <br /> Civision of Safety and Buildings Page 1 of -3 <br /> in accordance with Comm 85,Wis. Adm. Code /�Attach complete site plan on paper not less than 8 1/2 x 1 1 inches in size.Plan must CountytJ Gtr n <br /> include,but not limited to:vertical and horizontal reference point BM <br /> t� ( ).direction and Parcel I.D. <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. (%L t _ 90 7S„ C211ir <br /> Please print all information. Rewewec b 'i/ 1 <br /> Date <br /> Personal information you provide maybe used for secondary puroosas(Privacy Law,s.15.C4(1)(m)l <br /> PrOperty Cwner 2d S1.y`b 3 <br /> /t Property Location <br /> Ran it calf lla 4 Govt-Lot $w 114 NG�114 �-� T 416 Prpperty Owners Mailing AddressLot# Block z Subd Name o N R f E(or) <br /> d 7 3 17 5 ion e Ga�$ -s �- �.��,1 <br /> City State 41P Code Phone Number L <br /> WeSs�,✓r- OC`ry Village ®Town Nearest Road <br /> U✓.r S�f$53 �lSv) $6(�-t�yd6 1, an I l?ci tZ <br /> ❑ New Construdkxl Use:® Residential/Number of becrocros Code derived design low rate ROO <br /> Replacement ❑ Public or commercial-Describe: GPO <br /> Parent material G/,^cI f Ur'i f J Flood Plain elevation if applicacle /V 19 <br /> General comrnents <br /> and recommendations: <br /> m;��lel 9d•3 <br /> loi,t.�r qJ.9 <br /> a Borg o Boring pq <br /> r r Pit Ground surface elev. R. <br /> Depth to limiting factor > 7d` in. <br /> Horimn Scd Anolication Rate Depth Dominant Co{ Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Cu. SZ. Cont Color Gr.Sz.Sh. <br /> / --� 'E�x1 I 'Effz2 <br /> U-3 7.1'-(4 �- 1 s ln,s61c rY, iI <br /> ?-'-J- 7.5-1-4s/, — Fs Mir <br /> 3 a -S1 7..5 yR `ly — F 5 3 r�c161c-T n,f►- G 5 <br /> 1 I ff <br /> f <br /> I, � � 8orina# ❑ Boring <br /> I I Pit Ground surface elev.y ft Depth to limiting factor > 7•1- in. <br /> Soil Accfication Rate <br /> Horizon Depth Dominant Color Redox Descnptien Texture Structure Consistence Boundary Poots I GPD/f? f <br /> in. Munsell Cu.Sz. Cont. Color Gr.Sz. <br /> OL <br /> II,3- 40 7r5Y �/� <br /> 3 k�O` 7,s Y/l"/K1 s �ma6 k I <br /> GS <br /> IS y-7s >r r`f/d 4/4 -3- <br /> Effluent 91 =BCD >30<220_ mgiL and TSS >,0< 150 mg/L 'Ewen; BCD.<30 m I <br /> CST Name (Pl— C—t% _ g/L and TSS<30 mgiL <br /> Signature CST`umoer <br /> Jull7ES 5. 0 ►yl6/S U^'t� -S d.71 Y/fJ <br /> Address <br /> 0ate_vaivaoon Cenducted Telepnone Number I <br />