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e <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 /> '7µr <br /> Attach complete site plan on paper not less than 8 112 z 11 inches in size.Plan must County -eJJ <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. old - 90 Sd - 0/S00 <br /> Please print all information. Reviewed by Date <br /> Personal information you provide may be used for secondary purposes(Privacy Law,s.15.6(1)(m)). <br /> Property Owner Property Location <br /> /C 00 Govt.Lot 1/4 1/4 S /QT 110 N R 15- E(or <br /> Property Owner's Mailing Address Lot# Block# I SuW.Name or CSM# <br /> 5"Od•5- 0/;ver Ave S. <br /> City State Zip Code Phone Number ❑City ❑Village LK T wn Nearest Road <br /> /S A 1 S5-z//9 I ( G!a ) 9,tS- 1037 Jackseo 1604P l w4l Q <br /> [ja New Construction Use:0 Residential/Number of bedrooms 3 Code derived design flow rate 4d S"4 GPD <br /> ❑Replacement ❑ Public or commercial-Describe: <br /> Parent material lr/dk IeL/ Or. Fr< Flood Plain elevation if applicable ft. <br /> General comments S• .mac✓ q <br /> and recommendations: sir ok. 9 <br /> / Boring# <br /> Boring <br /> © Pit Ground surface elev. Z5. 4f ft. Depth to limiting factor 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 I •Eff#2 <br /> / O-4 7.SwZ-Y'- /S' /..r514/< H+ / cs _r n . 7 1. 6 <br /> 4,- 30 7.'rw? 4/zy — /S IM-4E l Gf 3co .7 /.6 <br /> 3 30-Gp t,5y/? `r/b — 15 /„ys6K ,y,/ G 3 d +z 7 A 16 <br /> do_pry r r/r -7 /. 6 <br /> ® Boring# ❑ Boring Q� <br /> ® pit Ground surface elev.�• V ft. Depth to limiting factor_,�_in. <br /> Soil Application Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIfF <br /> in. Munsell Ou.Sz. Cont.Color Gr.Sz.Sh. •Eff#1 •Eff#2 <br /> / 6- 4 7•SYR4d, /s Imsek 7 <br /> �• 9- 4Q 794R 14 — /S /�r156/c I GS 3C0 7 1. 6 <br /> S- -7.sr/? 4/to — /s /M16 k r 65 . 7 /• 6 <br /> s-74 7.5-10 m I 7 /, 6 <br /> Effluent#1 =BOD >30<220 mglL and TSS>30<150 mg/L •Effluent#2=BOO <30 rtxyL and TSS<30 mg/L <br /> CST Name(Please Print) Signature CST Number <br /> 6t6+aPs S. ,o 'Il 7SgA0 <br /> Address Date Evaluation Conducted Telephone Number <br /> X7760 M✓ 3r z6iebstr� wr 6-6tP-os 7/S 866-ri/r7 <br />