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or 'AL <br /> Wisconsin Department of Commerce SOIL EVALUATION REPORT 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. V ZqVSb 01 io00tv <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)). Z <br /> Property Owner ---J- <br /> Property Location <br /> MAW 14'Am Govt.Lot 1/4 1/4 S f T 440 N R S E(o W <br /> PropsOwner's Mailing Address Lot# Block# Subd. Name or CSM# <br /> �' ADD. A/- <br /> City State Zip Code Phone Number ❑City ❑Village JQTown Nearest Road <br /> Cr <br /> New Construction Use'M Residential/Number of bedrooms Z Code derived design Flow rate 0 _ GPD <br /> ❑Replacement ❑ Public or commercial-Describe: <br /> Parent material g1Agk Iii ft- Flood Plain elevation if applicable <br /> General comments �. Aa, %0 <br /> and recommendations: liGw <br /> 2p- : c y6.Z <br /> F1-1Bodng# [] Boring {� <br /> Ig Pit Ground surface elev._q10 ft. Depth to limiting factor 'O in. Soil Application Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM <br /> in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 I 'Eff#2 <br /> 5 1; Z s 2vt <br /> Z s1 s :2 41 .s <br /> 3 ,0 4 6 54 :2JK4hk m <br /> 4 0 •4 . 6 <br /> �Izan/ A 4 w <br /> Boring# Boring 17-49 <br /> E] pit Ground surface elev.�ft. Depth to limiting factor > 'J 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 /> 1 05 <br /> a s-40 7-,N-- 414 <br /> -S <br /> 40• 414 <br /> s•s� si <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 /> CSTNa%(Please Print) Signature CST Number <br /> ti! / 225SSS1 <br /> Addrest Date Evaluation Conducted Telephone Number <br /> 27760 �K 2-9-01 71S, $lo60-*57 <br />