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Wisconsin Department of Commerce SOIL EVALUATION REPORT O �'} I ! <br /> Division of Safety and Buildings R f of <br /> a <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),tlirection 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 ppp <br /> Personal information you provide may be used for secondary PUMOSeS(Privacy Law.s.15.04(1)im)). s' /•1 /� O.� <br /> Prooerty Owner <br /> 1 I Property Location <br /> NMAIAS Govt. .._ 56 1/4 /4 S �ST 3g N R -7 /°�� <br /> Property Owner's MaillncfAddress — / / E(oral <br /> of# Block# i SUDd. Name or CSM# <br /> qoo - III* AV_ N.w_ 763-755.1020 4o c <br /> State Zip Code Phone Number <br /> �b�1RRp�DS A*j 4city� FTown Nearest Rcatl <br /> I SS4331 ( 7 3)862 5 �bu-kb�✓►�i2 <br /> ew Construction Use)Q Residential/Number of bedrooms Code derived design flow rate <br /> ❑Replacement �GPD <br /> ❑ Public or commercial-Describe: <br /> Parent material_ L ]�- Flood Plain elevation if applicable — <br /> General comments C' q <br /> oral recommendations: 5 ys_ a . 92•O <br /> rr; <br /> Boring# rLJ Boring <br /> �{ pit Ground surface elev._q3'' ft. Depth to limiting factor.7 G�_ in. <br /> Soil A plication Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence i Boundary Roots I GPD/ff <br /> in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. <br /> 'Eff#1 <br /> ,A <br /> `T 56 a+ ✓ s <br /> 3 9 v •� s 9 <br /> I <br /> Borina# ❑ Boring Q <br /> 2 Pit Ground surface elev. � R Depth to limiting factor�I% in. <br /> Soil Application Rate <br /> Horizon Depth Dominant Color Redox Description Texture I Structure Consistence Boundary Roots GPD/ff <br /> in. Munsell Qu,Sz. Cont.Color Gr. Sz.Sh. <br /> — 4- Eff#1 'Eff#2 <br /> 1A y ,- <br /> W w s IMir -t <br /> ¢ i SJ111 AA ,Gj <br /> � L I <br /> Effluent#1 =BOD,>30<220 mg/L and TSS>30< 150 mg/L 'Effluent#2=BOD<<30 mg/L and TSS<30 mg/L <br /> CST Nam (Please Print) Signature <br /> f CST Number <br /> Address <br /> Date Evaluaticr.Conducted Telephone Number 1 <br /> Z66- 4s7 <br />