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Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of <br /> Division of Safety and Buildings <br /> in accordance with Comm e5,Wis. Adm. Code <br /> County Aqr <br /> Attach complete site plan on paper not less than 8 1/2 x 71 inches in size.Plan must <br /> Include,but not limited to:vertical and horizontal reference point(BM),direction and Parcel I.D. o,, <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. .3124010 <br /> Please print all information. Reviewed by Date <br /> Personal information you provide may be used for secondary purposes(Privacy taw,s.15.04(1)(m)). 5--/7—d <br /> Properly Owner ^` Property Location <br /> C <br /> VIAILG D:5M,446 Govt.Lot 1 1/4 1/4 SZ4TM N R 14 E( W <br /> P Owner's Maili^�Address Lot# Blodt# Stbd.Name or CW IV'- V'Il�I'E 5T• Z <br /> State Zip Code Number ❑City ❑Village 2kTown Nearest Road <br /> 0�1✓.�lu-off 22G 1 (6124 2-75 u <br /> JV New Construction Use: Residential/Number of bedrooms Code derived design flow rate GPD <br /> ❑Replacement ^ Public or commercial-Describe: /t, <br /> Parent material l�((;[I flt�r� ^ Flood Plain elevation if applicable <br /> General comments <br /> and recommendations: <br /> SV5 Ez- 94.9 <br /> ❑ Boring# ° Boring 9 -� <br /> Pit Ground surface elev. ft. Depthto limiting factor 7 1 in. <br /> Sal Application Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff <br /> in. Munsell Cu.Sz. Cont.Color Gr.Sz.Sh. •Eff#1 •Eff#2 <br /> / 0-5 7 syn . 7 /• Z <br /> 7. fL okAl S Zit . 7 11- 7- <br /> 7- <br /> /• 27 NA V4 A-] 1' . -7 <br /> i. <br /> 2 Boring# ° Boring <br /> -' pit Ground surface elev. q-7-r ft. Depth to limiting factor Z75- in. <br /> Sal ApOication Rate <br /> Horizon Depth Dominant Color Radox Description Texture Stricture Consistence Boundary Roots GPD/fl <br /> In. Munsell Qu.Sz. Cont Color Gr.Sz.Sh. 'Eff#1 •Eff#2 <br /> M 1 3 2jn '7 /.2 <br /> Z 5-37 <br /> 3 37-75 7 .7 l Z <br /> v <br /> Effluent#t=BOD >30:!220 mg(L and TSS>30:S 150 mg/L 'Effluent#2 BOD 130 mipt and TSS:5 30 mg/L <br /> CST (Please print) Signature CST NumberZl 4A 22.5$51 <br /> Data Evaluation Conducted Telephone Number <br /> 27-760 F} 3S Ess' �✓�. 54893 S-I�-o1 !s- bb-4t57 <br />