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Wisconsin Department of Commerce SOIL EVALUATION REW( -d- �<AAL <br /> Division of Safety and Buildings Page_of <br /> in accordance with Comm 85,Wis. Adm. Code <br /> Attach complete site an on County i3��r { <br /> p plan paper not less than 8 112 x 11 inches In site.Plan must <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. cob ).4.3,L 0/( /00 <br /> Please print al/information. Reviewed by Date <br /> Personal information you provide maybe used for secondary purposes(Privacy Law,s.16.04(1)(m)). / <br /> 418 1 <br /> Property Owner Property Location <br /> Ch i.les A lNefhern GovL Lot SW 1/4 sur 1/4 S 3A T 39' N R j ? E(oQQ <br /> Property Owners Mailing Address Lot# Block# I Subd.Name or CSW <br /> 0)( 161 e/0 1162,-f <br /> City State 41P Code Phone Number ❑City ❑Village Grown Nearest Road <br /> S/rfn I W1 t 54 (7(5`) 347-- 50e 04nl<<Sdot <br /> trlhf <br /> ❑ New Construction User Residential/Number of bedrooms 3 Code derived design flow rate z1 S O— GPD <br /> OrRepiacement ❑ Public or commercial-Describe: -- <br /> Parent material ot�fat u a I T, lFlood Plain elevation if applicable ATVf7 @. <br /> General commends k 1 g r e A o u f R o' <br /> and recommendations: Cr_ <br /> I p'� r < L, 4 <br /> Boring# ❑ Boring <br /> Pit Ground surface elev. 1126 ft. Depth to limiting factor 3_in. <br /> Soil ADdication Rate <br /> Horizon Depth Dominant Col Redox Description Texture Structure Consistence Boundary Roots GPD/fF <br /> in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. •Eff#1 •Eft#2 <br /> O-S -7.srn ;/� S lmsb/c m 1 GS X✓f <br /> 7 <br /> 4101)`sre <br /> 3 3- 90 S fR�y Gxcl s `/A r/� 56 fir• a.ns6/c m �, c S — , <br /> ya_W� !'7 A `'/b E S Y/1 5`/� s I 1 m s 6/C t� ' C <br /> ® Boring# ❑ Boring 9s <br /> ® Pit Ground surface elev. —ft. Depth to Ilmiting factor>V in. <br /> Soil Application Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDA? <br /> In. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 •Eff#2 <br /> 0-1 7,6W 11d, /S /M SO' rn I CS 36 • 7 /, ot <br /> �- 9-a8 SYR Y9 ectal f % s� ( d,,r,s6k ,-n K,' cs -- . Li 6� <br /> 3 }4-SO 6- lA JW/4' 015 . ? �IO` <br /> 4 -9g 71.f'iR y7 n,s a53 ryt 1 c S <br /> 1 -7 <br /> Effluent#1 =80D >30:S 220 mg(L and TSS>30<150 mg/L 'Effluent#2 BOD <30 _ <br /> _ _ _ mglL and TSS<30 rtpll <br /> CST Name(Please Print) _ Signature CST Number <br /> fi fs 6, .7 n l fe 15 J->3 y,i.Q— <br /> Address V Date Evaluation Conducted Telephone Number <br /> R 0 lie X y W fr r W 5-9 of S'-a- -6 715--866--70 eO- <br />