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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 /> �H!' <br /> Attach complete site plan on paper not less than 8 1/2 x 11 inches in size.Plan must County n/ <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. <br /> Please print all information. Reviewed by Date <br /> Personal information you provide me be used for seconds purposes(Privacy Law,S.15.04 1 m . <br /> Y P Y N P P ( Y I )( )) <br /> Property Owner /J Property Location <br /> FFA! e e, Govt.Lot SE 11450)1/4 S T2 N R A/17 E(o W <br /> Property Owner's Mailing Address Lot# Block# I Subd.Name or CSW <br /> 3 <br /> City State Zip Code Phone Number ❑City ❑Village Cglown Nearest Ropid <br /> �f� I'Ptsti L� <br /> ❑ New Construction Use:❑ Residential/Number of bedrooms _ Code derived design flow rate _GPD <br /> ❑Replacement ❑ Public or coat erclgi- esscribe: <br /> Parent material G�i4C iA /�/ j Flood Plain elevation if applicable ft. <br /> General comments <br /> and recommendations: © u <br /> Boring# ®–Boring . –7 <br /> ❑ pit Ground surface elev. . ft. Depth to limiting factor�/� in. <br /> Soil Application Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDN <br /> in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 •Eff#2 <br /> a <br /> 3 7. - <br /> F-1 Boring <br /> Boring# ❑ Boring <br /> Pit Ground surface elev. ft. Depth to limiting factor 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 •Etf#2 <br /> Effluent#1 =BOD >30<220 mg/L and TSS>30<150 mg/L 'Effluent#2=BOD,:5 30 mg/L and TSS<30 mg/L <br /> CST Name(Please Print Signature CST Number <br /> Address Date Evaluation Conducted Telephone Number <br /> w <br />