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Wisconsin DeparementofCommerce SOIL EVALUATION REPORT page of 3 <br /> Division of safety and Buildings <br /> • in accordance wflh Ctwrlm 85,Ms. Adm. Code �}— <br /> Attach complete site plan on paper not less than 81/2 x 1l Inches in size.Plan must l3 1 1 <br /> Include.but not limited to:vertical and horizontal reference Point(BM).direction and Parcel I.D. r� / 3 <br /> Percent slope.scale or dimensions.north amara.and 10=11 n and distance to nearest road. (� v' `t <br /> Please print all information. , <br /> Reviewed Date <br /> POW Ihfanr110 YOU pmride My be used fo►Seoohd:ry la.pose.(Pmaclr I aw.s.M04(1)(in)} �(J t1Vis D3 <br /> Property('owner c�3he�'i J Property Location 1 <br /> Ro 6-y i `a} rL �C C Q Govt.Lot d. . 1/4 + /4 S T 3C( R 14 E(or) <br /> Property Owners Mailing Address Lot# Block# Subd.Name or CSM# <br /> 12 ,L ca Rd 4 <br /> City State Zip Code Phone Number ❑City ❑Village ❑Town Nearest Road <br /> S4 WrWa I I ( 7/S) C-39_-2 yY /_: 4! Ad. <br /> ew Construction Use:❑ Residential/Number of bedrooms -2- Code derived design flow rate 3 O C7 GPD <br /> ❑Replacement ❑ Public or 00mmerC121-Describe: <br /> Parent material `r�e�Lr 4( /.t f • >L Flood Plain elevation if applicable ft. <br /> General comments <br /> and recommendations: <br /> E <br /> I Boring# ❑ Boring <br /> l Pit Ground surface elev. L ft Depth to limiting factor 9 C 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 •Eff#2 <br /> o - I. w, 3 — / S l -�-s6 /)v �� 210 /- � <br /> c)-s c M . 7 <br /> Boring# D<P❑ Boring <br /> Z <br /> It Ground surface elev. 0 ft Depth to limiting factor 1 d O In. <br /> Sal Applicator Rate <br /> Horizon Depth Dominant Color Redox Description HTexturetructure Consistence Boundary Roots GPD/ft= <br /> in. Munsell Qu.Sz. Cont Colorr.Sz.Sh. •Eff#1 •Eff#2 <br /> 7- u�� Q � I F . 2, <br /> S- 8 2Wr '` SG <br /> W-0 <br /> •Effluent#1 =BOD,>30<220 mg/L and TSS>30_<1 iflusnt#2 a BOD,<30 mg/L and TSS<30 mg1L <br /> CST Name(Please Print) Si CST Number <br /> John Solofra 22 779 <br /> Address ate Evaluation Conducted Telephone Number <br /> PO Box 161 ; Gordon, WI 54838 e � � ? 03 715-378-2278 <br />