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Wisconsin Department of Commerce SOIL EVALUATION REPORT Page t of 3 <br /> Division of Safety and Buildings <br /> in accordance with Comm 85,Wis. Adm. Code D <br /> CountyI7 )C144f' <br /> Attach complete site plan on paper not less than 8112 x 11 inches in size.Plan must <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. OZ /1 /00 <br /> Please print all information. Reviewed Date <br /> Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). <br /> Property Owner Property Location f <br /> Q V h�� Govt.Lot 1/4 1/4 S I T 40 N R 6 E(or <br /> Property Owner's Mailing Address Lot# Block# Subd.Name or CSM# <br /> ' 14 I th /. 1 Vol. 8 /q/ 0 <br /> city State Zip Code Phone Number ❑city ❑Village UTown Nearest Road <br /> IMA/155-JT3 o )B66- 04 A' r f <br /> ® New Construction Use: Residential/Number of bedrooms Z Code derived design flow rate 3O GPD <br /> ❑Replacement / ❑ Public or commercial-Describe: <br /> Parent material Ol6C�Lt f jo(f-Ict Flood Plain elevation if applicable IV401 ft. <br /> Ge er al comments Top <br /> 5 CL lop 4- &LI(y 6A)ro y <br /> G 3• <br /> Q �f <br /> go IF i ti} h! u rl G l -TwA;6? <br /> El Boring <br /> S-Yi2H/51( <br /> ❑ Boring# Q Pic 7 7 <br /> I Ground surface elev. � � 7 ft. Depth to limiting factor 7 in. Soil Application Rate <br /> Horizon I Depth I 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 /> I p_ 7, Z t.5 m5 r rr�L G5 2 (.2 <br /> 3 38-77 <br /> Boring# Boringp <br /> ® Pit Ground surface eiev. 9p, 7 ft. Depth to limiting factor 7 7 Lq in. Soil Application Rate <br /> Horizon4DepthDominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff <br /> Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. -Etf#1 'Eff#2 <br /> (.z <br /> e22,5 4 -- 3t. !m9 <br /> q'-73 17,6Ff? Z G5 1VF .6- cl <br /> Effluent#1 =BOD >30_<220 mg/L and TSS>30<150 mg/L -Effluent#2=BOD <30 mg/L and TSS_<30 mg(L <br /> CST Nie(Please Print) Signature CST Number <br /> K O �s <br /> Address Date Evaluation Conducted Telephone Number <br /> 27760 w (r.� frr Lj l' 484 q-5--03 715 946 -^�- <br />