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Wisconsin Department of Commerce SOIL EVALUATION REPORT Page_I of 3 <br /> Division of Safety and Buildings <br /> in accordance with Comm 85,Was. Adm. Code Countyr <br /> Attach complete site plan on paper not less than 81/2 x 71 inches in size.Plan must <br /> nett <br /> include,but not limited to:vertical and horizontal reference point(BM),direction and Pam I.D. <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. G 31 - 011 7S— Q f 1?60 <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)). l l ✓ <br /> b 2 <br /> Property Owner Property Location <br /> WO/14M q, dag-getioJivif 46mayl Govt.Lot SE 1/4 SE 1/4 S 13T 4t( N R /6t:17 <br /> E(or W <br /> Property Owner's Mailing Add Lot# Bbd(# Subd.Name or CSMA! <br /> '1611, i awe N, <br /> Cary State Zip Code Phone Number ❑City ❑Village ®Town Nearest Road <br /> Foi1d Go,c I W S4f93S—j ( ) Swf-$.$ L✓, i Red FOX TY, <br /> JO New Construction User Residential/Number of bedrooms �' Code derived design flow rate �! f0— GPD <br /> ❑Replacement ❑ Public or commercial-Describe: <br /> Parent material aet c f a / 42"i jzt Flood Plain elevation ff applicable !!%ZZ fL <br /> General comments s e(e v, 9d. A <br /> and recommendations: sy <br /> a Boring# E] Boring <br /> Pit Ground surface elev. 7(0r Sft. Depth to limiting factor 7 ��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 •Eff#2 <br /> d-4 7S` /?3/,— /S /.f,s6& . 7 X <br /> A u/ s ©s� vYl i s .11 . 7 l• �( <br /> s/9 — s os 6- )4� 1 G s — . 7 /• of <br /> Boring F71 # Boring <br /> ® Pit Ground surface elev. ft. Depth to limiting factor 7 5S in. <br /> Sal 'cation Rate <br /> Horizon Depth Dominant Color Radox Description Texture Structure Consistence Boundary Roots GPD/f' <br /> in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 'EfW <br /> 3CO 7 /• .( <br /> -36 7sY4 /6 — s os� ,�, I G 5 A n-1 <br /> os <br /> Effluent#1 =BOD >30:5 220 mg1L and TSS>30<150 mg/L •Effluent#2=BOD,:5 30 mg/L and TSS 130 mg1L <br /> CST Name(Please Print) Signature CST Number <br /> JMMEs -5, 041wr5 j 6L- 6�T 't4o— <br /> Address Date Evaluation Conducted Telephone Number <br /> 7760 ffw 3S Wg-A-51 °f- U/y S�P9 <br />