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WiisconsinDepartment ofCommerce SOIL EVALUATION REPORT Page--Lof <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 County <br /> include,but not limited to:vertical and horizontal reference point(BM),direction and paw I D 1 <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. CAS 194,$'0 O gd`00 <br /> Please Print all information. Reviewed by Date/� <br /> Personal information you provide may be used for secondary purposes(Privacy Law,5.15.00(1)(m)). 20 Wr 0 <br /> Property Owner Property Location ii�LL <br /> Bd. Po FFmAh Govt.Lot 1/4 1/4 S 13,T 4/0 N R /'/ E(or)® <br /> Property Owners Mailing Address Lot# Block# Subd.Name or CSW <br /> 7030 OaK F41/h1t Carle 7-8 1/ La/ce /Y/<ke.1 arrf Sob. <br /> City State Zip Code Phone Number ❑City, El Village ©� Town Nearest Road /4'"3 <br /> H1 'lJ. MN $XIt3 (95� ) 9y/- 9s 0/ 5edr//[ /Qa<Ine i7 <br /> ❑ New Construction use: Residential/Number of bedrooms at. Code derived design flow rate '3-00 GPD <br /> CO Replacement ❑ Public or commercial-Describe: <br /> Parent material G'/arc r-e- / /.J,•:fr Flood Plain elevation if applicable ti/H ft. <br /> General comments <br /> and recommendations: <br /> 140)P1*4 as G9 - -s her-Vtly 5&0&4444 0-# % .B: 6fe '54-a <br /> © Baring# E] Baring g <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/8T <br /> in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. •Eff#1 •Eff#2 <br /> / e- y 7.5'IR3/ 1.•rs5/c / GS 3n, . 7 /. b <br /> a �- syr y , — sal IM56k M{r s <br /> 3 dG-y0 7.SY/*? 'Ilq <br /> ❑ Boring# ❑ Boring <br /> ❑ Pit Ground surface elev. 11. Depth to limiting factor in. Sail rication Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundaryl Roots GPD/fF <br /> in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Efl#1 •Eft#2 <br /> r <br /> Effluent#1 =BOD >30<220 mg/L and TSS>30<150 mg& •E8luent#2=BOD <30 mlyfL and TSS 130 ffKJIL <br /> CST Name(Please Rini) ignalure CST lJrrtrlher <br /> JGh1e-s Sanfe/S j 734)0 <br /> Address V Date Evarris on Conducted Telephone Number <br /> e4 7760 X54. 3S G1Je los r4. wr s48s3 /o-01,L—6 9 7.r r,"- 41S7 <br />