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tment <br /> Division <br /> fsafetrandBurdings Commerce SOIL EVALUATION REPORT <br /> Divglon of Safety and Buildings / <br /> in accordance with Comm 85,Wis. Adm. Code Page / of <br /> an on paper not less than 8 1/2 x 11 inches in size.Plan must Cotmry (� L <br /> include,but not limited to:vertical and horizontal reference point(BM),direction and <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. Parcel I.O. <br /> Attach complete site pl <br /> Please print all information, oeviewed Z Date <br /> onQ 7ct� <br /> Penar informelion Rby <br /> you provide may be used for secondary pr+rposaa t >(Privacy law.s.15.04 1 I <br /> Property Owner <br /> Property Location I <br /> PropertyOwners MailingAddr�ss Govt Lot 1/4 1/4 S 35—T 3 VAq N R ( E(o <br /> ZZ �� Lot# Block# Subd. Name or CSM# <br /> Qty State Zip Cade Phone Number <br /> 6 W' S� ( /�) 6 ^Z977 C3 City Village Q2 Town Nearest Road <br /> ® New Construction Use:Lff Residential/Number of bedrooms <br /> ❑ReplacementCode derived design flow rate �O <br /> ❑ Public or commercial-Describe: GPD i <br /> Parent material 14 <br /> /474'e'z T•// <br /> General comments Flood Plain elevation if applicable <br /> and recommendations: R <br /> LIE5�5 F2- <br /> Boring <br /> Boring# ❑ Boring <br /> Pit Ground surface elev. R. Depth to limiting factor /Z in.D th n' <br /> Dep Dominant Cal Redox Description Texture Structure Consistence Boundary Roots Sod =hon Rate I <br /> in. Munsell U.Sz. Cont.Color GPD/fF <br /> I 6` .✓�Y� /Z —�—_— Gr.Sz.Sh. 'ER#1 I 'Etf#2 <br /> Z -1 7 7.5Y,2 6�y bl� !rl e5 Z.M <br /> L5 O� <br /> 17-70 7. FI 1-3 <br /> Dy <br /> ke zM1 <br /> y SYreg6 F ,esi 65 !Z <br /> l <br /> 1 L I Borinc# _❑ Boring <br /> LLL--)jj LJ Pit Ground surface elev. W-5 R. Depth to limiting factor_ �l <br /> Horizon Depth Dominant Color n. <br /> p Redox Description I Texture Structure Consistence Boundary Roots Sod AGPo;fF n Rate I <br /> in. Munsell Qu.Sz. Cont.Color <br /> I Gr.Sz.Sh. <br /> o-/v 7.5r 32 �` � .E�, •ER#2 � <br /> 2 <0-/8 7S ---- <br /> 3 <br /> y 1 �L/g z9 7S1e6 .71' 5 ,PS/ L S O� �L 6s <br /> _ <br /> ay'k5 2•�' !6 Figs 2si I I <br /> I I <br /> I i <br /> Effluent 41 =BOD >30<220 mg/L and TSS >30< 150 m E <br /> CST Name (Please Print) L. - P uent»2=BOD <30 mg/L and TSS<30 m L <br /> Signature - mg <br /> /L <br /> Number <br /> Address <br /> Dace Evaluation Conducted Telephone Numoer <br /> Zj7�0 3 W de%� LU.' si 3 2-/2,o Z r!71'6 <br /> 7 <br />