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Wisconsin Department of Commerce SOIL EVALUATION REPORT <br /> Division of Safety and Buildings Page I of <br /> in accordance with Comm 85,Wis. Adm. Code /� f 1 <br /> Attach complete site plan on paper not less than 8 112 x t 1 inches in size.Plan must County /7rAre <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 LD, <br /> Please Print all information. Reviewed by -yyZ v�4'Z 7e, <br /> Personal inr Date <br /> ennabon you Prov,o<may be used far secondary purbosea(PnvacY law,S.15.C3 j 1 <br /> (mi). <br /> Property 0"W <br /> 61IN 72 V / r Properry,Location <br /> l YI ( <br /> Pmpeny OwnersailingAddress Govt Lot Z 1/4 114 S2'5 T /�� N R S E(cr � <br /> p rL 24 Lot it Block# Subd. Name or CSAR# <br /> Qty State Zip Coca Phone Numper ❑Ci <br /> J ty ❑Village ®Town Nearest Road <br /> we er W: 5�l F (1!6 ) 866- 7278 0Arf' <br /> r� <br /> New Construction Use:® Residential/Number of becrooms 'J <br /> Code derived design now rate 1<� GPD <br /> F Replacement � Cl Public Orecommerdal•Describe: <br /> Parent material 614c. �/ r; <br /> A F!occl Plain elevation if applicable <br /> General comments %V5 <br /> and recommendations: f �/ <br /> Baring# ❑ Boring p/ <br /> Pit Ground surface elev. /b g. Depth to limiting factor 204 in. <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots Soil Application Rate <br /> in/ fF <br /> Munseed /-� Qu. Sz. Cont.Color <br /> _6 /`JrYK 7/G Gr.Sz.Sh. 'Eff#1 I •Eq#2 I <br /> �m� rrrnL Gni 12H7 7 <br /> Z 6-26 <br /> MZ_ _ I Z <br /> 26-3y 75vKs1Y c sK5' F5 lmsb /hFfl 6 — S !•Z <br /> Sonng# ❑ Boring <br /> Pit Ground surface elev. 9C/ R. Depth to limiting factor ZS_ <br /> In. <br /> Horizon I Depth Dominant Colorl Redox Description- i Texture Structure ConsistenceBoundaryl Rccts I Sotl�ccb�tion Rate <br /> s GPD/fF <br /> in. Munsell Gu <br /> SZ. Ccc or Sz S <br /> l _ <br /> 16 - 6 ,SY /Z I I S /rasa f Inn c 5 !! z/Yj l <br /> 2 6-ZS SYS 7 b Z <br /> O rnL 65 i rF � ,5 • <br /> 3 zs-y� zsrQsr�i �z sY s �s �s�k rnf2 6s <br /> I I I 1 ! <br /> 'Effluent#1 =BOD. >30<220 mg4 and TSS >3p< 150 mgA- •-M ! <br /> CST Name (Please Pnnt) = uent.2 = BCD <70 mgiL and TSS <70 mcGL <br /> _ Signature CST Number <br /> d/ <br /> Address <br /> Date Evaluation Conduced Telephone Ncmcer <br /> - -0 7 (7/ - x/57 <br />