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Wmconsin Department of Commerce SOIL EVALUATION REPORT Page_of <br /> Division of Safety and Buildings <br /> in accordance with Comm 85,Wis. Adm. Code <br /> County 14R J <br /> Attach complete site plan an paper not less than 8 112 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. <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)). <br /> PropeAy Owner Property Location <br /> Z iQ J <br /> Govt.Lot E iia I11W1/a S 52 T j$ N R /S E(or W <br /> Property Owns s Mailing Addrets Lot# Block# Subd.Name or CSM# <br /> 10 112 t�OAKAl- CEL (A- 40--(dam 1-a A4WS <br /> City State Zip Code Phone Number ❑Cily ❑Village tffTown Nearest Road <br /> -:71A PA/ i 551 I g 1 (661 )491- 3111 Cl4 <br /> New Construction Use.fiKResidential/Number of bedrooms Code derived design Row rate GPD <br /> ❑Replacement /� C1Public <br /> Aor commercial-Describe: <br /> Parent material t-t � ��tAw1:1' Flood Plain elevation if applicable R. <br /> General comments <br /> and recommendations: 5CI_5 Z <br /> Boring# ❑ Boring <br /> 0 Pit Ground surface elev. ft. Depth to limiting factor d 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 /> 2 s• 7 7. t, s c_o S 9 <br /> Jr y 4 4 vJfigi IV-, L <br /> Boring# ❑7i Boring <br /> 2 jg Pit Ground surface elev. 6 s ft. Depth to limiting factor in. (Application Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDtfF <br /> in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 I 'Eff#2 <br /> A-Sa s � i s cif ¢ 1.2 <br /> -95w X 6s1 3A wiv <br /> Effluent#1 =BOD >30<220 ng/L and TSS>30 1150 mg/L 'Effluent#2=BOD,:5 30 mg&and TSS<30 mg/L <br /> CST NarrA(Please Print) ,Si nature CS Number <br /> LII ! L..5S <br /> Add Date Evaluation Conducted Telephone Number <br /> 27760 Xy 'S_!� tAOS?F42Wi. 9$9_�; 3- 'L9- 02715- $66-4+s7 <br />