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Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of <br /> Division of Safety'and Buildings <br /> in accordance with Comm 85,Wis. Adm. Code <br /> County <br /> Attach complete site plan on paper not less than 8 1/2 x 11 inches in size.Plan must <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. 1-7 100 <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)). �� /0' <br /> Property Owner Property Location aL <br /> P f Govt.Lot 1/451/4 S/7T37 N R 115 fir)W <br /> Property Owners Mailing Address Lot# lock It Subd.Name or CSM# <br /> City State Zip Code Phone Number ❑City ❑Village X Town Nearest Road <br /> ) ' /.2 (6Sl ) 44 Al <br /> New Construction User Residential/Number of bedrooms Code derived design flow rate `, ®0 GPD <br /> ❑Replacement ❑ Public or com e -Describe: <br /> Parent material lrli/A Flood Plain elevation if applicable Q 6. <br /> General comments /44 f J /4 <br /> and recommendations: <br /> Boring# p❑ptl Boring 9 ,/ <br /> �y Pit Ground surface elev. r T ft. Depth to limiting factor in. <br /> Soil Application Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft= <br /> in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 'Eff#2 <br /> 7 <br /> Stip ,o <br /> Boring# ❑ Boring <br /> ® pit Ground surface elev.- 91 ft. Depth to limiting factor in. <br /> Soil Application Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz <br /> in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff# 'Eff#2 <br /> �S /1 — /i'l Zel <br /> 1—14 12419"?4014 ."SSP/l P <br /> Effluent#1 =BODS>30<220 mg/L and TSS>30< 50 mg/L 'Effluent#2=BODS<30 mg/L and TSS<30 mg/L <br /> CST Name(Please Print) + 1. lsignature- CST Number <br /> Septic Systems <br /> T 224173 <br /> AddressP.O. BOX 160 Date valuation C ucted Telephone Number <br /> SHELL LAKE,WI 54871 �! �� <br /> (715) 468.2434 `� <br />