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Wisconsin Department of Commerce SOIL EVARJA MINAt <br /> Division of Safety and Buildings Page I_of <br /> in accordance with Comm 85,Wis. Adm. Code —. <br /> Attach complete siteze.PlanCounty <br /> include,but not limited to:verticaal and horizontal reference poinches(BM),direction andmuss <br /> percents Parcel I.D. <br /> lope,scale or dimensions,north arrow,and location and distance to nearest road <br /> Please print all information. Reviewed by 1 Date <br /> Personal information you provide may be used for se000dary Purposes(Privacy law,s.15,04(1)(m)). <br /> P Owner Property Location 11 <br /> 1' Govt.Lot 1/4 1/4 S 3 T t N R t(0 E(o W <br /> P s Mailing Lot Al Block# Subd.Name or CSW <br /> State p Code Phone Number ❑City ❑village down Nearest Road <br /> DW W t .54630 ( <br /> New Construction Use:❑ Residential/Number of bedrooms _ Code derived design flow rat GPD <br /> ❑Replaoament Public or commercial-Describe: —5 t- BAR x 4'-?Lab�l 3,13 <br /> Parentmaterial _601t19L W[M Flood Plain elevation if applicable NA ft <br /> General corrrnents <br /> and recommendations: <br /> Sils. 9 7.0 <br /> Boring# ❑ Boring <br /> Pit Ground surface 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. <br /> Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 1 •Eff#1 •Eff#2 <br /> 1 <br /> 0-IL-111M sAA 67 kJ <br /> 2 - s A44 <br /> �8- If g .s <br /> aBoxing# Boring <br /> ❑ Pit Ground surface elev. - ft. Depth to limiting factor 15'+ in. 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. •EB#1 I •Etf#2 <br /> 0- <br /> - x <br /> aZAV 411, <br /> Effluent#1-BOD >30:!_220 mg/L and TSS>30<150 mg/L •Effluent#2-BOD,:!30 mg/L and TSS:S 30"OL <br /> CST Name(Please Print) _ Signature _ CST Number <br /> Date Evaluation Conducted Telephone Number <br /> 2-'7160 f y4 35 Vf-B5MK j W 7- 11-01 S 16b-4n <br />