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Wisconsin Department of Commerce SOIL EVALUATION REPORT <br /> Division of Safety and Buildings <br /> in accordance with Comm ti 5,Wls. Adm. Code - <br /> County N <br /> Attach complete site plan on paper not less than 6 v2 x 11 inchus.n sae. Plan must - —---- <br /> IrlolUde, <br /> but not limited to:vertical and horizontal reference point (OM),dueclon and Parcel I D. <br /> percent slope,scale or dimensions,north arrow,and location and dls Ma da to nearosl ro:rtl. Cj j 22 �, y �C ��_ <br /> Reviewod 6 Date <br /> Please print all information. D <br /> Personal infortnabon you provide may ee used for secondary purposos(Privacy Law,s 15.04(1)(m)) 2 `7 <br /> U,Op,,,7Owner Property Location <br /> �`� Govt. Lot 1!4tl4 S` 3 TYC N Rlj E (or 'l-j- <br /> Owner's M fling AddressLol# 61ock p Sut. Name ot�6SM# L/'7 - Qe-r^ Lodet`'Stato Zip Cale Phone Number ❑City ❑vylage 1}-Town -Nearest Hoe <br /> 6Z VJ <br /> ro <br /> Codo derived design now rate_ __-._____ ___..GPD <br /> New Construction Use:❑ Residential 1 Number or bedrooms___ --___ <br /> Replacement ❑ Public or commercial-DescridL. - -- ---- <br /> Flood Plain ole� on((applicable _ it <br /> Parent matorial____ ____-.- -------------- - <br /> General comments ^d / �� <br /> and recommendations. l�li1 T k—_ 0/1j( <br /> /1jlY <br /> LM_Iee,C 25 Gr Ca( - l�cna i _CoTAI°x_ 439 C -- <br /> Bodng <br /> Boring# ❑ Pit Ground surface elev.__ --- tt- - D,Pth to limding factor __. - ___ m. _ Soil A licaron Rate <br /> Texture St <br /> Horizon Depth Dominant Color Redox Description Structure Consistence Boundary Roots <br /> Eff#GPD/ft'E'fr12 _. <br /> in. Munsell Do.Sz. ContG <br /> . Color - ---- / 16 <br /> / <br /> CJ <br /> p—� �,5 3� �S - ---- 7 S / <br /> RY/ _ S - - -- - --.. <br /> ❑ Boring _-___in. <br /> Bonne# _ 11. Depth to limiting tactor ___ —_ Soil A licalion R�)tr� <br /> Pit Ground Surface elev.__--- GPDIff <br /> Texture Stntcfure Conslslmlce Boundary Roots <br /> Redox Description 'Eff#1 'EIM2 <br /> Horizon Depth Dominant Color Gr. 5z. s, -- <br /> in. Munsell Ou.Sz. Cont Color <br /> -1- _ <30 mglL and TSS<30 mg1L <br /> > _ t50 m Effluent#2-BOD _ CST Number <br /> Effluent#1 =BOD >30<220 mglL and TSS 30< <br /> Si4)n.taaturo <br /> CST Name (Please Print) <br /> ----- Tele—bur <br /> Evaluation Conducted <br /> Address __---__-�------ <br />