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Wisconsin Department of Commerce SOIL EVALUATION REPORT Page__of_ <br /> Division of Safety and Buildings <br /> in accordance with Comm 8S,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 U N <br /> include,but not limited to:vertical and horizontal reference point(BM),direction and parcel LD <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 may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). <br /> PfDy I <br /> er Property Location <br /> N Maq�N Govt.Lot 1/4 1/4 S ZST A16 N R /T E(or)o <br /> Property Owner's Mailing Address lot# Block# Strbd. Name or CSM# <br /> 9 r_ t r <br /> City State Zip Code Phone Number ❑City ❑Village 0 Town Nearest Road <br /> aN N1N s Sit (G l > 5' - y2 C e a t? <br /> New Construction Use:❑ Residential/Number of bedrooms�_ Code derived design Row rate GPO <br /> Replacement a ❑ Public or commercial-Describe: <br /> Parent material 6& ,C cit( Df-'7e-f- Flood Plain elevation if applicable t//t- ft <br /> General comments <br /> and recommendations: r/ q <br /> © Boring# ® Boring <br /> ❑ Pit Ground surface elev. �7d ft. Depth to limiting factor _in. <br /> Soil ADolication Rate <br /> Horizon Depth Dominant Color Redox Description Texture StructureConsistence Boundary Roots GPD/ff <br /> in. Munsell Cu.Sz. Cont.Color Gr.Sz.Sh. -ER#1 'Eff#2 <br /> 12, /Z L <br /> Z 7 ss�,eyj M� <br /> 3 -JA --------------- <br /> i <br /> L� Boring# ❑ Boring <br /> L_J ❑ Pit Ground surface elev._ R. Depth to limiting factor _in. <br /> Soil Application Rate I <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consist oundary RootsGPD/ff <br /> in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. �-Ef"f#1 -Eff#2 <br /> j <br /> Effluent 91 =BOD >30:S 220 mg/L and TSS>30< 150 mg/L Effluent#2=BOD,:<30 mg/L and TSS<30 mg/L <br /> CST Name (Please Print) Signatu CST Number <br /> T l lee- /nq I <br /> Address Date Evaluation Conducted Telephone Number <br /> 71t- - g157 <br />