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Wisconsin Department of Commerce SOIL EVALUATION REPORT Page I of /l <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 Rr-10,n Q7"IL <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. 03y— ISA, 03d,06 <br /> Please print all information. Revie by Date <br /> Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)) ? �, <br /> Property Owner Property Location <br /> 6eraldlne u Govt.Lot NW 1/4sA/1/4 S Oka, T 37 N R IF E(or W <br /> Property Owner's Mailing Address Lot# Blodr# Subd.Name or CSM# <br /> //86 /'/w 1/6' YO /9c re--5- <br /> City <br /> esCity State Zip Code Ptwne Number ❑city ❑Village I@ Town Nearest Road <br /> Fr ee-# c cr/s (71r)-v L7- J-Oak Tads lekn I HLvy 2,47 <br /> ❑ New Construction Use:® Residential/Number of bedrooms Code derived design flow rate yS0 GPD <br /> ®Replacement ❑ Public or commercial-Describe: <br /> Parent material G/aC/a 7- // Flood Plain elevation if applicable NSA ft. <br /> General comments e/ % <br /> and recommendations: S� 7 09 A/0 mom/ing obsc�� <br /> wa'fe+S�EcQ�„'f /a tidt/sic <br /> /nf•e✓al r1+Orrmrny <br /> © Boring# ❑ Boring q 7 > 6 <br /> 0 Pit Ground surface elev. ft. Depth to limiting factor 3 in. <br /> Soil Application Hate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM? <br /> in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 -Eff#2 <br /> 6-13 7.SYQ 3/4 /S awvd k ,. l I cs 3 f . 7oiL <br /> /-7-J4, 7S'`Ik "/4 /f:5 divrsbk <br /> -36 7.S-`I4 9/ — G 3 MRdk rnVF; <br /> Boring# Boring <br /> ® Pit Ground surface elev. yj d ft. Depth to limiting factor 3 8 in. <br /> Soil Application Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM <br /> in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 'Efl#2 <br /> 7ftiRj/ /� �tiLsbk ml CS 3f.7 <br /> m �b /a`S okms6k ,n f r' C s ..5- . 9 <br /> Effluent#1 =BOD >30<220 mg/L and TSS>30<150 mg/L 'Effluent#2=BOD <30 mg/L and TSS 130 rng1L <br /> CST Name(Please Print) SignatureCST Number <br /> �7 <br /> Address Y Date Evaluation Conducted Telephone Number <br /> 47760 1(w 35— GtJ ��js1�t°r W S�ftfS3 //- 7-03 <br />