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Wisconsin Department of Commerce SOIL EVALUATION REPORT Page Ofma <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 8 112 x 11 inches in size.Plan must <br /> include,but not limited to:vertical and horizontal reference point(BM),direction and Parcel 1 p <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. 4r b 6#0 S 0 D. <br /> Please print off information. Reviewed by Date <br /> I� I <br /> Personal informationyou provide maybe used for secondary purposes(Privacy Law,a.15.04(1)(m)). 2 Lcf- <br /> Property Owner Property Location �l <br /> Q6 re,n2l Govt.LolS N01/4NIVA1455 T YON R /yE( )W <br /> Property Owner's Mailing Address Lot# Block# I Subd.Name or CSW <br /> /59`21 re-M D- 8 o r r N L U__ <br /> cityState Zip Code Phone Number ❑City ❑Village ®Town Neanist Road <br /> q12mN I 5S IaYic ) sc 0�1 & /q- <br /> 12 <br /> New Construction Use:® Residential/Number of bedrooms Code derived design flow rate GPD <br /> ❑Replacement /` ❑ Public or commercial-Describe: _ <br /> Parent material_ 1.7�+a UQ / o L44L„-'%L, Flood Plain elevation if applicable <br /> General comments / r! <br /> and recommendations: SI/Sl _ ��v�� )p h� _ Ar 9 <br /> fro 91r G 86rv� �wrrac� �, 3 � <br /> ❑ Boring# ® Boring <br /> / ❑ Pit Ground surface elev. / —� ft. Depth to limiting factor 2 7 in. <br /> Soil kation 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 /> I <br /> 04 7,SYg 9`/a nom <br /> 2- 5-777,SY9 S/9` rlermcS <br /> F <br /> Bodrtg# ❑ Boring pit <br /> ® pit Ground surface elev. 'l ft. Depth to limiting factor) 7C�_ in. <br /> Sal 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 /> / p-9` 7,Sys y/a. 7 �. <br /> a- <br /> 57a �Sy2s/ n sIS <br /> Effluent#1 =BOD >30<220 nVL and TSS>30 1150 mgA. •Effluent#2=BOD <30 mg1L and TSS<30 mglL <br /> CST Name(Please Print) Signature CST Number <br /> na. /VVIT 3S7/ <br /> Addressif Date Evaluation Conducted Telephone Number <br /> 2-5,13 1 to troy 7/S as 7 <br />