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Wisconsin Department of Commerce SOIL EVALUATION REPORT ` ' I G I N A L <br /> _ <br /> Division of Safety and Buildings Page of <br /> in accordance with Comm 85,Wis. Adm. Code <br /> o`'1-V <br /> Attach complete site plan on paper not less than 8 1/2 x 11 inches in size.Plan must County r`+r <br /> Include,but not limited to:vertical and horizontal reference point(BM),direction and parce' <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. <br /> Please print all information. Reviewed by Date <br /> Personal information you provide maybe used for secondary purposes(Privacy Law,s.15.04(1)(m)). - ,y�� <br /> Property Owner n Property Location <br /> yO <br /> �l 1 M , ALj{� Govt.Lot 1/4 1/4 S 12,T A6fo N R E( )W <br /> Property ownees Mailing Address Lot# Block# S Name or CSWZo AM07r C-1 - 35 v V. <br /> City State Zip Code Phone Number ❑City ❑Village own Nearest Road <br /> Mlnlnl IJ M 55343 t(vi2 ) - S, n1 jz <br /> ❑ New Construction Use:X Residential/Number of bedrooms___ Code derived design flow rate_ GPD <br /> Replacement A ❑ Public or commercial-Describe: <br /> Parent material UL&ML Pw Flood Plain elevation if applicable <br /> General commends <br /> and recommendations: C,,( 0—. 9:z .-3 <br /> FT <br /> Boring# ❑ Boring Ll� <br /> Pit Ground sulfate elev. ft. Depth to limiting factor in. <br /> Soil Application Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF <br /> in. Munsell Cu.Sz. Cont Color Gr.Sz.Sh. 'Eff#1 `Eff#2 <br /> 0_4 3 Is 059 W Ce 2-co, .1 I,?- <br /> Is <br /> .2IS M rk1 0 2.to 'T 1. 7- <br /> 3 is as �r H 5 t,z <br /> Boring# <br /> © Boring <br /> ❑ Pit Ground surface elev.�Ty_ft. Depth to limiting factor, 6*7 in. <br /> Soil Application Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM <br /> In. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. •Eff#1 'Eff#2 <br /> El <br /> Effluent#1 =BOD >30:5 220 mg/L and TSS>30<150 mg& •Effluent#2=BOD <30 mg&and TSS 130 mg/I_ <br /> 'KitName$Ago nt)kl�S Signature - 2_ <br /> z?T31 <br /> Date Evaluation Conducted Telephone Number <br /> 13?6o 3S �. I�1i $q3 8- 7-00 K- 966- s <br />