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Wisconsin Department of Commerce SOIL EVALUATION REPORT Page—L of J <br /> Division of Safety and Buildings <br /> in accordance with Comm 85,Wm. Adm. Code <br /> Attach complete site plan on paper not less than 812 x 11 Inches in size.Plan must County S A w n e7/-- <br /> include,but not limited to:vertical and horizontal reference point(BM),direction and Parcel in <br /> percent slope,scaleor dimensions,north arrow,and location and distance to nearest road. <br /> p 1) � `-76410 O el qo O <br /> Please print all information. Reviewed by Date <br /> Personal infomueon you provide may be used for secondary purpose,(Privacy Lew.c.15.04(1)(m)). c 0/ <br /> Property Owner Property Location (' <br /> Gkkc/e Nit/,awm GovL Lot 3w 1/4 illW1/4 S kA TcA!�) N R /.f- E(or4g) <br /> Property(Tuner's Mailing Address Lot# I Block# I Subd.Name or CSM* <br /> 33g 1n/an� far3y <br /> City State Zip Code Phone Number ❑City [3 Village ®Town Nearest Road <br /> /04-p le z,-, vnN iSSgr/ go/ 69– /96 Jovckgoo 5,7veee"':h Tr= <br /> N1 New Construction Use:® Residential/Number of bedrooms_L Code derived design flow rate 300 GPD <br /> ❑Replacement ❑ Public or commercial-Describe: <br /> Parent material 6:1,1u^ / Qr:{t Flood Plain elevation'd applicable /f// ft <br /> ti <br /> and recommendations: (Fvw q/.0{ 91400 is sN66a) <br /> /d. 7 <br /> Boring# ❑ Boring ��v <br /> Pit Ground surface elev. i .,{L ft. Depth to lim"factor 7 SO in. <br /> Soil Application Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD <br /> in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eft#1 'Eff#2 <br /> O- y 7S-tR 3/ /S /�16k .,, / 3co 7 <br /> ot ei-ao 7.S-4R `'/ — 15 IM Sxk- .+,/ G S 3co <br /> e. V 7,S`r/74/y — /,S /,„,J�k S .4 .7 /.6 <br /> Lie-80 SYR `r/4 — r Oslo v.+ ! — — '7 <br /> Boring# ❑ Boring <br /> ® Pit Ground surface elev. QS a ft. Depth to limiting factor 7 80 in. <br /> Soil kationRate <br /> Homan Depth Dominant Color Redox Description TexWre Structure Consistence BoundaryRoots GPDAF <br /> in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. •Eff#1 'Eff#2 <br /> o- y 7.sYR% l / /InsSK her/ e5 ?eo 7 /• 6 <br /> el <br /> 11-.0 y 7.54/?y/y — /,S /.=416/e »r/ (r 5 3 eo . 7 /. <br /> 3d 4,919 SK? '5/4 <br /> Effluent#1 =BOD >30<22D mg&and TSS>30<150 ffxA 'Effluent 92=BOD 130 mglL and TSS 130 mg4 <br /> CST Name(Pleaselh�) Signature CST Number <br /> ✓AI1f4) >34A0 <br /> Address Date Evaluation Conduced Telephone Number <br /> ".7764 f/— 3s— w�bstr, wr sy�j 3-d9-ori 7ys- 866- `/is7 <br />