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Wisconsin Department of Commerce SOIL EVALUATION REPORT <br /> Division of Safety and Buildings Page/of <br /> in accordance with Comm 85,WIS. Adm. Code <br /> Attach complete site plan m paper not less than 8 1/2 x t t Inches in size.Plan must Cowry <br /> include.but not limited to:vertical and horizontal reference point(BM),direction and <br /> Percent slope.scale or dimensions,north arrow,and location and distance to nearest road. Parcel I.D. <br /> Please print all information- ytiZs 0z <br /> Reviewed by Date <br /> PoraMal lnteeeet-On you provide may es umd for Secondary purueso IPnvaey Law,s.15.04 t <br /> ml). <br /> Property Owner <br /> Property Location <br /> ohN T u!7 far <br /> �+ g Govt Lot z 1/4 t/4 S Z ST yb N R /7 E(pr <br /> Property Owner's arhn Atldrass Lof# Black# SWttl. Name ar CSM# <br /> gas rack � � <br /> C'h Stara Zip Cade Phone Numoer I <br /> 1 .n _ ❑Cily Q Vpaga ®To" Nearest Road <br /> ❑ New Construction Use:® Residential/Number of becrcoms 3 Code derived design flow rate r' <br /> Replacement GPC <br /> P ❑ Public o�rocommerdal-Describe: <br /> Parent material_,�/QC.(/ O,, rf� <br /> ral comments <br /> ,f L Flood Plain elevation if applicacle 4 <br /> and erecommendations: <br /> 7 Yd <br /> Boring# ❑ Boring p <br /> pit Ground surface elev. /lP•L ft, Depth to limiting factor 2_in. <br /> Horizon Depth Dominant ColaRedox Description Texture Structure Consistence Boundary Roots I Soil A GPO�n Rate <br /> in. Munsell Qu,Sz. Cont.Colcr Gr.Sz.Sh. <br /> —6 �SY27 'Eff#t � •Eq92 I <br /> / 6t M/_ GS ziai 7 <br /> Z 6-26 ,SY2S/ /=5 0 ry` 17 I I I Z <br /> 26-39 7 S yKs1Y G S eb% FS lvnzb /hFlL 6 - I S ! /-Z <br /> I I <br /> i I Sonna# _❑ Boring <br /> I Z Pit Ground surface elev. f. Depm to limiting factor in. <br /> So;l Aocl;padpn Rate <br /> �HffnzonDepth Dominant Color) Redox Descnpticn Texture Structure Consistence Boundary) Rcots GPDIff <br /> in. Munsell Qu.Sz. Cont.Coicr Gr, Sz. Sh. li <br /> I 1D -67SY�3/2I L�j i /rrs mLG`l z/7 ; 7 Z <br /> _ X51 SYS os rnG 1 65 / F I -� <br /> 3 2SA 7SYQS�4 CZ 5 r S IGS I ify6� rljffl 6S - <br /> I I <br /> I I I i I I I I <br /> I <br /> Effluent 91 =BOD >30<220 mg/L and TSS >20< 150 mgryL 'Ef.uent 92 =BOD c 30 mgrt and TSS <JO mgrL <br /> CST Name (Please Pint) Signature <br /> 7d,4/ _ CST Number <br /> Address Date Evaluation Conducted Telephone Numcer j <br /> (7/ 7 <br /> , <br />