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Wisconsin Department of Commerce SOIL EgALUATON REPORT <br /> Division of Safety and Buildings Page��of_j <br /> in accordance with Comm 85,Wis. Adm. Code <br /> Attach complete site plan on paper not less than 8 1/2 x 11 inches in size.Plan must County <br /> Include,but not limited to:vertical and horizontal reference point(BM),direction and <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. Parcel I.D. <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 /> Properly Owner Property Location <br /> R Govt.Lot /vW1/4 �/4 S d-- T <br /> Property er's Mailing Address Lot# Block# Subd. Name or CSM# '�Fa N R /-7 E(or) <br /> 110 <br /> City <br /> S <br /> State Zip Code Phone Number ❑City ❑Vllage Town <br /> � Nearest Road <br /> S5Dl (�i12) - ql3 Nlo�l �cvlJ Uig. 1zv- <br /> CZ New Construction Use: Residential/Number of bedrooms Code derived design flow rate <br /> -- GPD <br /> ❑Replacement <br /> ❑ Public or commercial-Describe: <br /> Parent material--.. •si Jac ma Xifr -- Flood Plain elevation if applicable <br /> General comments ft. <br /> and recommendations: Sys• -e 6ov. �'! S <br /> aBoring# ❑ Boring q/ <br /> cga pit Ground surface elev. /(O r 7 ft. Depth to limiting factor RJ_ _in. <br /> Soil Application Rate <br /> M7, <br /> Color Redox Description Texture Structure Consistence Boundary Roots GPDM <br /> ll Qu.Sz. Cont.Color Gr.Sz.Sh. <br /> `Eff#1 •Eff#2 <br /> /� � � 3<o r7 /.,�% rnOSSy !.� <br /> 172—/ I Boring# ® Boring <br /> L_--1 ❑ Pit Ground surface elev.�l�e• 7 ft. Depth to limiting factor 3 _in, <br /> Soil kation Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff <br /> in. Munsell Qu.Sz. Cont.Cola Gr.Sz.Sh. MEEM <br /> 4.4 <br /> A Al-3b �.sYq •s/ s 3'Y e- sy � <br /> Effluent#1 =BOD >30:5 220 mg/L and TSS>30:5 150 mg/L •Effluent#2=BOD 130 mg/L and TSS<30 mg/L <br /> CST� P(Please Print) Si nature <br /> CST- <br /> t - A�,J� <br /> 2.17100 �� �� ' to Evaluation Conducted Telephone Number <br /> - <br />