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- <br /> WisconsinDepartment ofCommerce SOIL EVALUATION REPORT ORIGINALPage__of__ <br /> Division of safety and Buildings <br /> in accordance with Comm 85,Wis. Adm. Code <br /> wmmAttach complete site plan on paper not less than 8 112 x 11 inches in size.Plan must County <br /> include,but not limited to:vertical and horizontal reference point(BM),direction and Parcel I.D. <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. 629 04- lop <br /> Please print all information. Reviewed by Date <br /> Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). / O <br /> Property Owner Property Location <br /> -TcI <br /> z-o Govt.Lot 1/4 1/4 ST N R q E(or <br /> Property Owner's Mailing Address Lot# Block# Subd. Name or CSM# <br /> City Stat Zip Code Phone Number ❑City ❑Village 5 Town Nearest Road <br /> 1 J 6SAR. <br /> ❑ New Construction User Residential/Number of bedrooms _ Code derived design flow rate W GPD <br /> Replacement ❑ Public or commercial-Describe: <br /> Parent material l thl, ()Y1.wr Flood Plain elevation if applicable fl. <br /> General comments <br /> and recommendations: <br /> F-11 <br /> Boring# 2 Boring R , <br /> ❑ pit Ground surface elev._ v• ft. Depth to limiting factor �Yo in. <br /> Soil Application Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF <br /> in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. •Eff#1 I •Eff#2 <br /> D' 4 2k IL 5 <br /> 66 751ig V4 Zyrs <br /> Boring# Boring 96 3 <br /> I I ❑ Pit Ground surface elev. ft. Depth to limiting factorin. <br /> Soil Application Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF <br /> in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. •Eff#1 'Eff#2 <br /> 0-4 zylxglt <br /> Z its <br /> Effluent#1 =BOD >30:<220 mg/L and TSS>30<150 mg/L Effluent#2=BOD <30 mg/L and TSS<30 mg/L <br /> CST Na (Please Print) Siture CST Number <br /> f gna2258s1 <br /> Addrest Date Evaluation Conducted Telephone Number / <br /> 2.77do XAV 3s W57&1? 7ts� S�6-4+s7 <br />