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Wisconsin Department of Commerce SOIL EVALUATION REPORT Page--�_of z <br /> Division of Safety and Buildings <br /> in accordance with Comm 85,Wis. Adm. Code <br /> Attach complete site plan on paper not lass than a 12 x 11 inches in size.Plan must <br /> minty rwrn Y '� <br /> Indude,but not limited to:vertical and horizontal reference point(BM),direction and Percy I.D. <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. O 3d - Sd,Z L`• O 3- 900 <br /> Please print all information. Reviewed by Date <br /> Personal inform flon you provide my be used for secondary purposes(ftvacy Law,s.15.04(1)(m)). —424"ob <br /> i 2 "Q$ <br /> Proper�tyOrwner Property Location <br /> �t, <br /> z Ar Y 14r 71t U5T GovL Lot 2 $4w 1/4 WW 1/4 S 'fi b T N/ N R ft E(or)o <br /> Property Owner's Mailing Address Lot# Block# Subd.Name or CSW <br /> rs-1 I g v.h St- ot y V. 'Y All <br /> City State Zip Code Phorl Number ❑City ❑Village ®Town Nearest Road <br /> MAA ICato Mlu I SdoI ( .5w1S5 Elrcf Je4n .n /�� <br /> ® New Construction Use:❑ Residential/Number of bedrooms Code derived design flow rate GPD <br /> ❑Replacement ❑ Public or commercial-Describe: <br /> Parent material l/Ac rA fye f i<t Flood Plain elevation if applicable A1iy ft <br /> General comments <br /> and recommendations: /7r i t, 1< C3e r r 5 <br /> MAMO A5 <br /> 644Lf,Vb SAfab (ay) "'max d<�y a e ,�;1' •• v� <br /> Boring# ® Boring O� t- <br /> ❑ pit Ground surface elev.tea,J- ft. Depth to limiting factor ?I -" in. <br /> Sal Application Rate <br /> Horizon Depth Dominant Color Radox Description Texture Structure Consistence Boundary Roots GPD/fF <br /> in. Munsell Qu.Sz. Cont Color Gr.Sz.Sh. 'Eft#1 'Eff#2 <br /> / o- y 7-'V J& — iS 7 /. 6 <br /> u- v 7r1•R% — s 7 /. 6 <br /> 4j SY 7.J-107%y — S • 7 6 <br /> Boring# ❑ Bones <br /> ❑ pit Ground surface elev. ft. Depth to limiting factor in, <br /> Soil ADDlication Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/R <br /> In. Munsell Qu.Sz. Cont.Color Gr.Sz Sh. -Eff#1 I •Eff#2 <br /> Effluent#1=BOD >30<220 mg/L and TSS>30<150 ffKA 'Effluent#2=BOD <3D mglL and TSS<30 not <br /> CST Nacre(Please Print) Signature CST Number <br /> utn S �ItI Lm/.S S D 7-*yko10 <br /> Address V Date Evaluation Conducted Telephone Number <br /> ?7(o0/ft� 3 S lUeA,flfrr GO-Z7 S-49�,3 7is� £164- 4/S7 <br />