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Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of <br /> Division of Safety and Buildings <br /> in accordance with Comm 65,Wis. Adm. Code <br /> County 1v �— <br /> Attach complete site plan on paper not less than 8 112 x 11 inches in size.Plan must 16 ee <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. o y — O <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)). e �r✓ O <br /> Property Owner Property Location C <br /> ,-/r f *'� Govt.Lot Y 1/4 1/4 S / T 3k N R I5"-E(or <br /> Property Owner's Mailing Address Lot# Block# I Subd.Name or CSM# <br /> O o L 1- <br /> City State Zip Code Phone Number ❑City ❑Village Town Nearest Road <br /> -4*00 e P Groo r A41 i '5So77 1 ([5.5"X)yST--7573 L /'n < C/'/�•u 6�r� I-V S/i <br /> ❑ New Construction Use:(K Residential/Number of bedrooms Code derived design flow rate GPD <br /> Weplaoement ❑ Public ormenliall--Describe: <br /> Parent material �-�'l/'�C e,,4/ �'! T 7z" Flood Plain elevation if applicable <br /> General comments A e 1 T IP P�Q c t cd/c- 3' 3 3.4 <br /> and recommendations: G4n.,v (�r N �^��v�f�.a�.i t/h���^ o c� a �✓ <br /> -f IBJ Ir...✓..yL�v`r ce/A1,44r'3 <br /> Boring# E] Boring <br /> R Pit Ground surface elev.q 7, ft. Depth to limiting factor >7 _in. <br /> Soil Application Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff <br /> In. Munsell Ou.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 I 'Eff#2 <br /> O-S 7,5-%eIRE lS /,0if/e rs,V�i <br /> r39 0 .P yi <br /> 7-70 lee pe, <br /> Boring# 0 Boring <br /> a P. Pit Ground surface elev. <�ft. Depth to limiting factor 7 7,L 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 'Eff#2 <br /> 1,21 <br /> S-i�s D rQ `�/ /IIS V�r ���. -7 <br /> ys7� <br /> Effluent#1 =BOD >30<220 mg/L and TSS>30:S 150 mgA- 'Effluent#2=BOD,:E 30 mg/L and ISS:E 30 mg/L <br /> CST Name (Please Print) Signature CST Number <br /> alt /Z� 100:0%7 Al 4,,4�- 0.227 6 9'/ <br /> Address Date Evaluation Conducted Telephone Number <br /> Ad 0 <br />