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WiisconsinDepartinentofCommerce SOIL EVALUATION REPORT Page--�—of 3 <br /> Division of Safety and Buildings <br /> in accordance with Comm 85,Wis. Adm. Code <br /> (36+rn61`f- <br /> Attarh complete site plan on paper not less than 8112 x 11 inches in sire.Plan must County <br /> include,but rat 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. OA O WOO 637e&> <br /> Please print all information. Reviewed by Date <br /> Z442 v4", <br /> r <br /> Personal Information you provide my be used for secondary purposes(Privacy Lew,s.15.06(1)(m)). O <br /> Properly Owner Property Location <br /> s<dr 7`f 7 i Is e tcLl GovL Lot St 1/4 S -114 S :?4 T y0 N R /G E(or)a <br /> Property Owner's Mailing Address Lot# I Blo*# I Subd.Name or CSW Vol 0 //2 <br /> Zi A A h s's. 5'E 1 Ce , fvb.eF 461 0" Lot ) Uk 1- <br /> city <br /> City State Zip Code Phone Number ❑City []Village ®Town Nearest Road A 7a Jd <br /> M /s rMA1 I S'S-%elsi 1 (611 ) 377 -M-9D OAK/RNar I E. Ddv;/e //A/W <br /> ❑ New Construction Use:® Residential/Number of bedrooms -1 Code derived design flow rate 300 GPD <br /> ®Replacement ❑ Pudic or commercial-Describe: <br /> Parent material 6i,At 1,4 / 0,:E1 Flood Plain elevation If applicable f6 <br /> General oormrenfs <br /> and recommendations: G rn. f Gen��ry on-Sri?"G <br /> AM910 AS /tAR15602& 10AO �%C <br /> Boring# ❑ 'ng 79 9 <br /> Pit Ground surface elev. ft. Depth to limiting factor 7 71r in. <br /> Soilloation 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 '0192 <br /> i D-4 -.Vs-5RJ�r, /.S /Mfsi& A" / C 3 Fjr . 7 �• <br /> ,- 4f- ;RAs'IR `r/ /1b1i olkapoVL C AMA/c M r G s sc o ,Z <br /> 3 3,l•to ,SYR `il — LS lr.." »1uFr X . 7 1. <br /> SO- 72 7.5 Ye #cc S 05% IM — 7 <br /> Boring# ❑ <br /> Boring <br /> ❑ Pit Ground surface elev. ft. Depth to limiting factor in. <br /> g 71Application Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDW <br /> in. Munsell Cu.Sz. Cont.Color Gr.Sz.Sh. •Etf#1 'ER#2 <br /> Effluent#1 =BOD >30<220 mWL and TSS>30<150 mg/L •Effluent#2=BOD,:5 30 mg/L and TSS<30 mWL <br /> CST Name(Please Prim) - - Signature CST Number <br /> A M YJ -S Dan bels ,S OA-� 1101703 5101 O <br /> Address Date Evaluation Conducted Telephone Number <br /> )77(ao 3S- wedsfev W. $-rj 9 !3 9-37 6 a- gis7 <br />