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Wisconsin Department of Commerce SOIL EVALUATION REPORT Page / of 2 <br /> Division of Safety and Buildings <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 !.�Cotalty k Y H L° <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. W-0- 4141- orJ00 <br /> Please print aft information. Reviewed by Date <br /> Personal information you provide may to used for secondary purposes(Privacy Law,s.15.01(1)(m)). <br /> OG <br /> Property Owner Property Location <br /> 7d n'( //eeyo h GovL Lot .va/ 114,V,6'114 S t/ T H0 N R/y E( <br /> Property Owner's Mailing Address Lot# Block# Subd.Name or CSM# <br /> A 9177/ 7�rtasa+e .r4 <br /> City State Zip Code Phone Number ❑City ❑Village 10 Town Nearest Road <br /> 494"A-- j, wt 4830 ( ) ,S-4e'1/" I Ca /Pe/. A <br /> ❑ New Construction Use:❑ Residential/Number of bedrooms Code derived design flow rate GPD <br /> ❑Replacement Public or commercial-Describe: 499 v,-y .t>e!w//S/arc e_ <br /> Parent material /ir u w Flood Plain elevation if applicable <br /> General ccrtarierits <br /> and recommendations: <br /> F-/1 <br /> Boring# ❑ Boring t� <br /> 10 Pit Ground surface elev. /�ft. Depth to limiting tactor 96 in. <br /> Soil Application Rate <br /> Horizon I Depth I Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff <br /> in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. •Eff#1 I •Eff#2 <br /> 0 -3 S'rd MA F.- ore <br /> 3- 41 7•5-W? Yq /FS Jw+s61- , , / G S Af S' 40 <br /> 3 y1-60 SYR y/y /FS o(w+sb' »1 / GS If • S' /• O <br /> . 7 /- 4 <br /> w i1`H � s dw c1S •S1//r� y�� <br /> Boring# ❑a Boring � Op® Pit Ground surface elev. 9P-42 ft. Depth to limiting factor>in. <br /> Soil Application Rate <br /> Horizon Depth Dominant Cola Redox Description Texture Structure Consistence Boundary Roots GPD/IP <br /> in. Munsell Cu.Sz. Cont.Color Gr.Sz.Sh. •Eff#1 I •E11#2 <br /> O-3 7SY/7�^ + �•^ zC <br /> 3- yl 7.s 1•R%4 — /FS A"s-4k rr/ GS / S- /.© <br /> 3 91-68 SYR lP — /F5 ,9 .1564 / GS — s- /. 0 <br /> t( 8-85 I 7.s9h Yf /S IwS6k r — — 7 /ep <br /> W/tti 11tS 6a."4 SYR Vf 5 0 <br /> •Effluent#1 =BOD >30:5 220 mgfL and TSS>30<150 mg& •Effluent#2=BOD <3p mglL and TSS<30 mglL <br /> Name Nae( se PleaPrint) - - Signature CST Number <br /> awl 8.S /fan/ C/s SQ 735'/+O <br /> Address Date Evaluation Conducted Telephone Number <br /> 77 0 »S.• 3Sr,ve6.94r, Av-� -4W9.3 3 ^ l- O6 �7/S-9106-vis7 <br />