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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,Wis. Adm. Code <br /> County V PNL <br /> Attach complete site plan on paper not less than 8 1/2 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 /> Prope Owner Property Location <br /> L r 11j Al 1 n/ Govt.Lot T� 1/4 1/4 S Z/y <br /> T L'I I N R E to <br /> Property Owners Mailing Address Lot# Block# Subd. Name or CSM# <br /> 457 W ,"2 d.,,.� c M W P3 8 <br /> City State Zip Code Phone Number ❑City ❑Village XTown Nearest.Road <br /> 1 ► Xreelv i 1..9: 536// 1 (66 3 ) 9+2-tn w: &2VA <br /> New Construction Use: Residential/Number of bedrooms Code derived design flow rate y'Jr� GPD <br /> ❑Replacement ❑ Public/o1r commercial-Describe: <br /> Parent material m'?Jr 7 P toil p_pral comments / ,rFlood Plain elevation if applicable ��� ft. <br /> Genand eecommmendaflons: 4,Y15, �� /0-/ 9D l0� <br /> Maqwas: Ay-kn1 90. 3 (89. 72 44. '92. 3L <br /> D A% ?6mro y Gm kMidol To 35rob - P6yntbq-J�;ems4j real C- <br /> © Boring# Boring <br /> ❑ pit Ground surface elev. ft. Depth to limiting factor <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 /> I o e" 2 e — Ly .7 Z <br /> 6 7. ' yY jY1�j 2 <br /> /_Z <br /> Boring# ❑ Boring > 6 <br /> pit Ground surface elev.eft. Depth to limiting factor_�in. <br /> Soil Application Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' <br /> in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. •Eff#1 I 'Eff#2 <br /> l <br /> 0-1 Z 1r7 <br /> Z - t , err 04 tlkZ GS Jt ( Z <br /> 341A 7 d:K 1_ <br /> 'Effluent#1 =BOD >30:5 220 mg/L and TSS>30<150 mg/L 'Effluent#2=BOD <30 mg/L and TSS<30 mg/L <br /> CName (Please Print) ignur CST Number <br /> 6 5, G/ <br /> Address tsi Date Evaluation Conducted Telephone Number <br /> 0727V <br />