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Wisconsin Department of Commerce SOIL EVALUATION REPORT Page--L of <br /> Division of Safety and Buildings <br /> in accordance with Comm 85,Wis. Adm. Code Q <br /> B z/ N <br /> Attach compete site plan on paper not less than 81/2 x 11 inches in size.Plan must Canty <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. Revi b Date <br /> Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). �/ (Or <br /> Property Owner Property Location )OC/ <br /> e (-1^ 5 d'�j Govt.Lot ! )scl 1/4;74j 1/4 S,7,. T3 79 N R /.6 E(or <br /> Property Owner's Wailing Address Lot# Block# WW-Wame or CSM# <br /> 4W 14 5- e/W 3 — s' <br /> City State Zip Code Plane Number ❑city ❑Village ®-Town Nearest Road <br /> 1AJe6s��r w 3 ( W66-XlPo� w Z 3-5 <br /> ❑ New Construction Use: esidential/Number of bedrooms Z Code derived design flow rate 30 o GPD <br /> S:RReplacement � Public or commeraal-Describe: �— <br /> Parent material c_7�19 C 214 Z a r i�J` Flood Plain elevation if applicable � ft. <br /> General comments <br /> and recommendations: s�lS{G �LEt/R-NOA) 49 q7 <br /> Boring# ❑ Boring r _ <br /> Pit Ground surface elev. ft. Depth to limiting factor 5 o 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 'Efffl2 <br /> -4 , 1 ^ 1-5 h, L S 7 i. <br /> 44 1;7dl <br /> ` <br /> © Boring# Boring <br /> E] pit Ground surface elev. 1 Z ft. Depth to limiting factor _�7- in. Soil Application Rate <br /> Horizon Depth Dominant Conor Redox Description Texture Structure Consistence Boundary Roots GPDHF <br /> in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 'Eff#2 <br /> o- 7.sYlP is , 7 <br /> Effluent#1 =BOD >30<220 mg/L and TSS>30<150 mg/L 'Effluent#2=BOD,:5 30 mg/L and TSS<30 mglL <br /> CST Name(PleaseSignature CST Number <br /> c✓ d Cf �/� G.)e,..e4 z z 76 9/ <br /> Address k Date Evaluation Conducted Telephone Number <br />