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Wiaeonsin Department of Commerce SOIL E Vi4LUQL K141IRT 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 Paroel 1 p /� <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. OUIioI <br /> Please print all Information. Reviewed by ata ry <br /> Personal information you provide may be used for secondary purposes(Privacy Low,s.15.04(1)(m)). <br /> Property Owner Property Location <br /> f}uL Govt.Lot 1/4 1/4 3 T k N R E(o W <br /> P Owner's Mailing AcIdress Lot# Block# Subd.Name or CSM# <br /> N <br /> CRY State Zip Code Phone Num City [IVil a own Nearest Road <br /> MN ( - 39 R n/ <br /> ❑ New Construction Use'ME Residential/Number of bedrooms Code derived design flow rate_ Z-3� GPD <br /> Replacement ❑ Public or commercial-Describe: <br /> Parent material 61. Flood Plain elevation if applicable ft, <br /> General comments <br /> and recommendations: <br /> sys fL, gs-. <br /> 71 Boring# ❑ Boring <br /> Pit Ground surface elev.��ft. Depth to limiting factor in. <br /> Soil Application Rate <br /> Horizon Depth Dorninant 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 /> O.5 s D ,w1 leo /. 2- <br /> 7 <br /> 2 Ms 09 A4 --' Co <br /> o ao,;rng#� Boring <br /> ❑ Pit Ground surface elev. 7/ O ft. Depth to limiting factor t7 in. <br /> 77� Soil Application Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDttf <br /> In. Munsell Qu.Sz. Cont Color Gr.Sz.Sh. •Etf#1 I 'Eff#2 <br /> ! 0-$ A <br /> �- )- o Ml <br /> Effluent#1 =BOD >30 1220 mglL and TSS>30:<150 rrg1L 'Effluent#2=BOD,:5 30 rtg&and TSS:S 30 malt. <br /> CST Narmjfleassl Pmt) CST Number <br /> Address Date Evaluation Conducted Telephone Number <br /> 2-7760 �S 1^l sr�rz Wl. S�gg3 (0- 7-S- 61 71s- 6-44 <br />