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Wisconsin Department of Commerce SOIL EVALUATION REPORT Page I of -3 <br /> Division of Safety and Buildings <br /> in accordance with Comm 85,Wis. Adm. Code <br /> 17 <br /> Attach complete site plan on paper not less than 8 712 x 11 inches in size. County L7e.Plan must 8u' n e t/— <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. O-3 d 9ddS Oct O D D <br /> Please Print all information. Reviewed by Date <br /> Personal information you provide may be used for secondary purposes(Privacy Law,S.15.04(1)(m)). /I03 <br /> Property Owner Property Location <br /> Vr Czar fe�� Govt.Lot 1/4 114 S 3 ST eyl N R/b-/7E(or&) <br /> Property nets Mailing Address Lot# Block# Subd.Name opeft# <br /> / 366 r c osSH 60Y c. /oA LAN AcaEs <br /> City State Zip Code Phone Number ❑City []Village EfTown Nearest Road (<77c, <br /> 2BJcf t MN 1SSO68 (/o.S-/ ) 344- 8d7a S rJs r0 e.v.. Gan <br /> ❑ New Construction Use:® Residential)Number of bedrooms <br /> �_ Code derived design flow rate c%S7 GPD <br /> ®Replacement ❑ Public or commercial-Describe: <br /> Parent material G'1441 A / c,7.-:Te'* Flood Plain elevation if applicable /Z/"R ft, <br /> General <br /> recommendations: $yJ• e <br /> and rele✓ 43. .5-o. - ( 93. 17 -6 93. 56 <br /> and <br /> Pope,( & '5-0 ,z - <br /> Boring# ❑ Boring <br /> pit Ground surface elev. 7q.5- ft. Depth to limiting factor > 7a( in <br /> Soil licetion Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDlfP <br /> in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. •Eff#1 'Eff#2 <br /> ,C y• Ha 7.5417 % — /S �7.-.s6/c ,.,, l 4 5 3co . 7 /, 6 <br /> Boring# ❑ Boring <br /> © Pit Ground surface elev. 9fi.S ft. Depth to limiting factor > /d O in. <br /> Soil Application Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDflf <br /> in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. •Eff#1 •Eff#2 <br /> / 0- 9' 7.s9R -1A — y-S /„+ s6/c <br /> p� /S 71S6/1- <br /> 3 e-so <br /> Effluent#1 =BOD >30<220 mg/L and TSS>30<150 mg/L 'Effluent#2=BOD <30 mryL and TSS<30 nxyL <br /> CST Name(Please print) Signature CST Number <br /> J' nkl" s [�nleIJ s J� 7-TWo <br /> Address Date Evaluation Conducted Telephone Number <br /> ?760ff1 3s G(leb.s><e� C- Z-- -5' /e -s/- 08 lir- 86G- v/r7 <br />