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Mi, 'wql t2 J, <br /> 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 B 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. Q., da- <br /> �O <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. '02e— l0 u <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)). /S Q <br /> Property wrier Property Location <br /> LOWGovt.Lot 1/4 1/4 S T N R E(or W <br /> Pro Owner's Mailing Address Lot# B # Subd. Name or CSM# <br /> rty h 1 V f P�9 <br /> 3o oTm(z 1-k- RD . <br /> Ci State Zip Code Phone Number <br /> ❑City ❑Village own Nearest Road <br /> Vo <br /> New Construction Use` Residential/Number of bedrooms _ Code derived design flow rate GPD <br /> Replacement L?l Public or commercial-Describe <br /> Parent material n Flood Plain elevation if applicable 1—P« ft. <br /> General comments <br /> and recommendations: <br /> sys_ Q. 93. 6 <br /> Boring# Ya Boring A <br /> pit Ground surface elev._/ * 49 ft. Depth to limiting factor 2— _in. <br /> Soil Application Rate <br /> Ho tizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff <br /> in. Munsell Qu.Sz. Cont.Calor Gr.Sz.Sh. 'Eff#1 'Eff#2 <br /> 1 o-S 73 /1-a s <br /> Z S- t: w <br /> 3 37-7 9 7, n+s <br /> Boring# Boring A / <br /> 2 ❑ pit Ground surface elev._[�• 6 ft. Depth to limiting factor -773 <br /> _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 -5 s <br /> z <br /> 6-34 M5 <br /> 3 3 <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 (Please Print) §iggature CST Number <br /> u! 22SSs1 <br /> Add to <br /> Evaluation Conducted Telephone Number <br /> 27760 W37f Wl. 59� o <br /> 866-4157 <br />