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Wisconsin Department of Commerce SOIL EVALUATION REPO R I G I N A Lge_of_ <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 a 1/2 x 11 inches in size.Plan must County Gff <br /> include,but not limited to:vertical and horizontal reference point(BM),direction and Parcel 1.0 <br /> Percent slope,scale or dimensions,north arrow,and location and distance to nearest road. b((Q.. Q 5— 01 Q� <br /> Please print all information. Review n� Date <br /> Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1) <br /> ProPerriOwner Property Location ! i <br /> ,Jcfrrc>d vi", (/C) iU Govt Lot /v 1/4-5&/1/4 S T 1 4 <br /> Propel Owner's Mailing dress d ( N R E(or) <br /> d lot# 81ock# Subd,Name or CSM# <br /> 3 41 <br /> State Zip Cade Phone Number ❑City ❑Village r�� <br /> //t/jy� �n �j -q p llmeg ®Town Nearest Road <br /> kNl�Nur �../',` �{ /� (Zl )7i lD i - '7f�o r�eell D r- <br /> New Construction Use:® Residential/Number of bedrooms Code derived design flow rate <br /> GPO <br /> ❑Replacement /� ��' Public or commercial-Describe: <br /> Parent material r�� rr,f -/p(,�e Flood Plain elevation if applicable f/� <br /> General correnents —ft. <br /> and recommendation: g �L ./�R 5t P66 O <br /> t0 � <br /> west 47.0 <br /> RyS <br /> D Boring# ❑ Boring <br /> Pit Ground surface elev. ft. Depth to limiting factor 1) 0_in, <br /> Horizon Depth Dominant Caor Redox Description Texture Structure Consistence Boundary Roots SodGPDApplication Rate <br /> in. Munsell Ou.Sz. Cont Color Gr.Sz.Sh. •Eff#1 I •Eff#2 <br /> 1 -'1 7,6W R2 Z <br /> � � Z 75Y/� /3 Zy O L 65 i� .Y 1•Z <br /> / <br /> 1 ' I Boring# L❑] Boring p <br /> u t�] pit Ground surface elev. Qr�D ft. Depth to limiting factor > 7 n. <br /> Soil Application Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/f? <br /> in. Munsell Cu.Sz. Cont.Color ) Gr. <br /> �Sz. <br /> /S/h'. �r Eff#1 •Eff#2 <br /> 7 � <br /> z -96t IV Yle 719 <br /> -x leye me <br /> 'Ovz e6 VF <br /> I <br /> bnf // L 7., J'/* � <br /> I <br /> Effluent#1 =BOD >30<220 mg/L and TSS>30<150 mg/L Effluent 92=BOD <30 mg/L and T S<30 mg/L <br /> CST Name(Please Print) Signature CST Number <br /> o <br /> Address Date Evaluabon Conducted Telephone Number <br /> 21760 3 Wc,d 12 <br />