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wtconsinDepanmentofCommerce SOIL EVALUATION REPORT IR <br /> Division of Safety and Buildings I \. Page v Of_ <br /> in accordance with Comm 85,Wis. Adm. Code <br /> County <br /> Attach complete site plan an paper not less than B 1/2 x t 1 inches in size.Plan must <br /> include,but riot 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. O/Z 11207 0 2- <br /> Please <br /> Please print all information. ReviewedDate <br /> Personal information you by provide may be used for secondary purposes(Privacy law,s.15.04(1)(m)), f 2, <br /> I "77 <br /> Property Owner Property Location <br /> Nn1 7-,#— e" Govt.Lot 1/4 1/4 S 7 T y0 N R /S E(or&)i <br /> Property Owner's Mailing A ress Lot# Block# I Subd.Name or CSM# <br /> QS ti ^jd v /8 <br /> City State Zip Code Phone Number ❑City ❑Village ®Town Nearest Road <br /> A/oiMN 5 (5n7)663-774V- a--04r50^j I /r(q„n Lk- <br /> ® New Construction Use:[Z Residential/Number of bedrooms Z Code derived design flow rate 340 GPD i <br /> ❑Replacement ❑ Public or commercial-Describe: <br /> Parent material >61� v 12,r,#XL Flood Plain elevation if applicable /U✓f- ft. <br /> General comments / E. c P W. �nfp <br /> and recommendations: G/�/�j FG qy 93.q4- <br /> Ar- <br /> Boring# ❑ Boring® 94. 6 y <br /> pit Ground surface elev. ft. Depth to limiting factor in. <br /> Soil Application Rate <br /> Horizon Depth 1 Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff <br /> in. Munsell Ou.Sz. Cont Color Gr.Sz.Sh. •Eff#1 •Eff#2 <br /> 0-5 -75 k m1 e 2,ol . 7 t <br /> Z <br /> —6--6y 7 5'Y1 NA 6'> '7 /Z <br /> 6Y-7b 2I- R 2114f F11- 6-IV679 mF5 2m,54k /qr&f 6S /✓F 5— <br /> Boring <br /> Boring# ❑ Boring <br /> pit Ground surface elev. 95-6 ft. Depth to limiting factor 6o in. <br /> Soil Ao licabon Rate I <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF <br /> in. Munsell Ou.Sz. Cont.Color Gr.Sz.Sh. •Eff#1 'Eff#2 <br /> l <br /> It)-Z( 7.SYi<7/Z 15 ,✓hL G Gj e?A7 • 7 1 -7 <br /> Z -60 m.2 rel /Z <br /> 3 - 72 z. ,yoeyi IF�6re6'1Zm c 4Z r/L 67 i . 5- 1 <br /> i <br /> I <br /> Effluent 41 =BOD_>30<220 mg/L and TSS>30<150 mg/L Effluent R2=BOD <30 mg/L and TSS<30 mg/L <br /> CST Name (Please Print) Signature CST Number I <br /> C <br /> Address Date Evaluation Conducted Telephone Number <br /> �7/0 964- 'l/57 <br />