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Wisconsin Department of Commerce SOIL EVAWATIOPFf NAL page__of_ <br /> Division of Safety and Buildings <br /> in accordance with Comm 85,Wis. Adm. Code <br /> County <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. 3CO <br /> Please print all information. Reviewed by D <br /> Personal information you provide maybe used for secondary purposes(Privacy Law,s.15.04(1)(m)). 4L <br /> 7///`/Li/ <br /> Property Owner nl Property Location <br /> WAU /r Govt.Lot 1/4 1/4 S S T40 N R 15 E(or <br /> P Owner's Mailing Addresli Lot# I Block# Subd.Name a CSM# <br /> 0 . D to V.I/. <br /> City State Zip Code Phone Number ❑Cdy ❑Village Town Nearest Road <br /> 65 :rAi.K5Vd <br /> New Construction User Residential/Number of bedrooms Code derived design flow rate GPD <br /> ❑Replacement ❑ Public or commercial-Describe: �f� _ <br /> Parent material U P L tales Flood Plain elevation if applicable MR --ft. <br /> General continents <br /> and recommendations: <br /> Boring# H Bonng d7 3 <br /> Pit Ground surface elev. _ft. Depth to limiting factor in. <br /> Sod Application Rate <br /> kHonzon Depth Dominant Colo Redox Description Texture Structure Consistence Boundary Roots GPD/ff <br /> In. Munsell Ou.Sz. Cont.Cola Gr.Sz.Sh. 'En#1 'Eff#2 <br /> o-+ ',- -t -4-26 4 <br /> _0 <br /> Boring# Boring <br /> pit Ground surface elev. ft. Depth to limiting facto >Nz 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 /> 0- Z 13 <br /> 7- -2 6 <br /> Effluent#1 -BOD >30<220 mg/L and TSS>30 1150 rtg& 'Effluent#2=BOD <30 mg/L and TSS 130 mg/L <br /> CST (Please Flint) Signature - CST NumberC{� I 2zSSSl <br /> AddreA I Date Evaluation Conducted Telephone Number <br /> 2-7760 715 S106-+S7 <br />