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e <br /> Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of <br /> Division of Safety and Buildings <br /> in accordance with Comm 85,Wis. Adm. Code �p <br /> U u y N <br /> Attach complete site plan on paper not less than B 1/2 x 11 inches in size.Plan must County e trU <br /> include,but not limited to:vertical and horizontal reference point(BM),direction and Parcel l D <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. - q- <br /> —�p <br /> Please print all information. Reviewed by Date <br /> Peron[information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). <br /> Property Owner / Property Location <br /> UtrI/ JfrOtn 6ru Govt Lot Si✓ 1/4 NW 1/4 S .ls' T `/D N R /6 E(or) <br /> Property Owner's Mailing Address Lot# Block# I Subd. Name or CSW <br /> d 7W ')Anson l Ild <br /> City State Zip Code Phone Number <br /> ❑City ❑Village ®Town Nearest Road <br /> Webst<cv WJ- 1 6-4Vq-3 6- 71S' Q k/ate J41AM40n C.4 lid <br /> IL New Construction Use: Residential/Number of bedrooms 3 Code derived design flow rate 11(10 GPD <br /> ❑Replacement )) ❑ Publicor commercial-Describe: <br /> Parent material �IAc r 06 1 L2r i 7,6 Flood Plain elevation if applicable <br /> General comments yS• r/� <br /> and recommendations: 1� 7 <br /> / ung# Boring <br /> ® pit Ground surface elev. 9 71 ft. Depth to limiting factor X-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 I •Etf#2 <br /> G'4 7rsth Y4 /s Os5 / 6 3 7 /,d <br /> 4.4g 7"rm �// lnS v5s :sjs 3G0 r7 /r <br /> d$-3# 7151 4/ —` tl�S <br /> 4 35'-S3 71$-y-4"16 — .f 6s5 nr 55 7 l d <br /> S S3-5-4 514 `//9 td S`M AV 1�5 l9 6-j <br /> (� sb- 70 <br /> 1. l Boring# Boring <br /> II II pit Ground surface elev. f7i'4 ft. Depth to limiting factor `7r�in. 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 /> 6-4 7Stli 3 1 /S oSS 1+1 1 C5 3ce) 7 116 <br /> 4/-41 7,5-9A '09 -- rhd e65 mi .t5lS 3e0 , '7 /. al <br /> 3 99�s6 7,S v C cQ `S fR �8 z{S 055 Yh rCi 9 S rry r'5' r 9 <br /> `f 65=75 <br /> Effluent#1 =BOD >30:S 220 mg/L and TSS>30<150 mg/L 'Effluent 92=BOD,:5 30 mg/L and TSS<30 mg/L <br /> CST Name (Please Print) Signature CST Number <br /> Address V Date Evaluation Conducted Telephone Number <br /> a� <br /> 7760 �k- 35- We 6sfyr LY-:SF-IK03 2,7- <br />