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Wisconsin Department of Commerce SOIL EVALUATION REPoO R 1 G!N A ge__of <br /> Division of Safety and Buildings <br /> in accordance with Comm 85,Wis. Adm. Code <br /> Attach complete site plan on paper not less than 8 1!2 x 11 inches in size.Plan must County <br /> include,but not limited to:vertical and horizontal reference point(BM),direction and Parcel I.D. ry <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. ® 6 a O d ©6 <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)). 19-016Z <br /> Prop Own t Property Location <br /> e e Govt.Lot 1/4 1/4 S 3G T Yo N R l SrE(or) <br /> Prop6ffy Owner's Mailing Address Lot# Block# Subd. Name or CSM <br /> '3/6 13 i Lnl. /I�� 3 V• l /3 <br /> C^i� State Zip C Phone Number ❑City Village Town Nearest Road 3 6 a8 <br /> ,�31 l A mIj SS 3 ( 3 )7SS-IS�� .4c�5 a.rJ e /uitJ5 y/ <br /> ❑ New Construction Use: Residential/Number of bedrooms _ Code derived design flow rate GPD <br /> Weplacement 1-+ 1 ❑ Public;or comme(rciali Describe: <br /> Parent material C r ji/k G1 r/ f Flood Plain elevation if applicable ft. <br /> General comments Q <br /> and recommendations: C oM /G "!/ <br /> /QeP/,4CQ w//�i /liauivol S.p <br /> Boring# [3 Boring QG� a <br /> —pit Ground surface elev. 3 ft. Depth to limiting factor �7D—in. <br /> Soil Application Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM <br /> in. Munsell Ou.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 'Eff#2 <br /> 0 -3 7- A d �. � <br /> 02 3-7V 7, <br /> Boring# E] Boring <br /> !L 1X1 O—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 'Eff#2 <br /> a-z 7. 15 Ml 12- <br /> Effluent <br /> . 2Effluent#1 =BOD >30:5 220 mg/L and TSS>30 1150 mg1L 'Effluent#2=BOD <30 mg/L and TSS<30 nVIL <br /> CST Name(PI � <br /> Address Print)) u �`�B/ ! Signatu � CST Number/ G� Date Evaluation Conducted Telephone Number <br />