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Wisconsin Department of Commerce SOIL EVALUATION REPORT Page / of <br /> Division of Safety and Buildings <br /> in accordance with Comm 85,Wis. Adm. Code <br /> Attach complete site plan on paper not less than 81/2 x 11 inches in size.Plan must <br /> County <br /> L3rn.r fi le 7t <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. Q/L— rfd./3— O 1700 <br /> Please print all information. Revue y Date <br /> Personal inform ion you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). /14c, 6 3 <br /> Property Owner / a" Property Location <br /> ' a--/ Govt.Lot S E' 1/4 ffi5'1/4 S /3 T $10 N R '1$r E(o <br /> Owners r <br /> Property Oer's Mailing Address Lot# Block# Subd.Name or CSM# <br /> if s <br /> ,m <br /> city Ln aPr+ 3/0 <br /> City State) Zip Code Phone Number Q City ❑Village <br /> m lLWddd �/r' SSll9 9 ®Town Nearest Road <br /> (6s7 ) 738-76'19 Jac(c.6on rid Rd. <br /> ® New Construction Use:® Residential/Number of bedrooms oZ Code derived design flow rate 3D0 GPD <br /> IrReplacement ❑ Public or commercial-Describe: <br /> Parent material 6/AC4'OL/ O r i tey- Flood Plain elevation if applicable ft, <br /> General comments 74. X t' 96.5 <br /> and recommendations: <br /> Boring# Boring <br /> / ® Pit Ground surface elev. 95 ft. Depth to limiting factor 7 d in. <br /> Sal ADDlication Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/tF <br /> in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. `Eff#1 'Eff#2 <br /> 7.S-)-/? a — is /Msbk / e s 3 M . 7 /. d <br /> 7 s M µ/y Fs 056 0/ 6S )� M S— . 7 <br /> 3 4d -71 -7 s-5'/1 'r/q -- FS O SG m I G S -s- <br /> Boring <br /> SBoring# Boring Ground surface elev. 97 S— ft. <br /> pit Depth to limiting factor > 70 in. <br /> Sal kation Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff <br /> in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 I `Eff#2 <br /> l o -4 7.5-t/A — /s i.aa6k <br /> J, 9-36 74 I? / fs OS(r U t !r S 3c0 -6- <br /> 3 6-7e <br /> 6-36-78 7.r jy — fs t G 5 / s- . 9 <br /> Efliuent#1 =BOO >30:5 220 mg/L and TSS>30<150 mg/L `Effluent#2=BOD <30 mglL and TSS<30 rtglL <br /> CST Name(Please Print) SignCST Number <br /> 1JAph F,5 S• Dion l''/s a reS'6a'� a.734fot 0- <br /> Address U Date Evaluation Conducted Telephone Number <br /> o•7 7jo 0 M�y3S` U/e6s/ems f1- 7-03 7is=8dG-7ogp- <br />