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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. <br /> Please print all information. Reviewed by Date <br /> Personal information you provide may be used for secondary purposes(Privacy Lew,s.15.04(1)(m)). <br /> Property Owner Property Location <br /> Govt.LM 1/4 1/4 S T N R E(or)W <br /> Property Owners Mailing Address Lot# Block# I Subd.Name or CSM# <br /> I>`1 <br /> City State Zip Code Phone Number ❑City ❑Village g ❑Town Nearest Road <br /> GPD <br /> E-1NewConstruction Use:El Residential/Number of bedrooms _ Code derived design flow rate <br /> ❑Replacement El Public or commercial-Describe: <br /> Parent material Flood Plain elevation if applicable ft. <br /> General comments <br /> and recommendations: <br /> Boring S7 pit <br /> r 7 pit Ground surface elev.�__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 'Eff#2 <br /> ! -s s Cs � � �, z <br /> .7 i.z <br /> s•?r t rte-- Af3 os /YL! AM 7 �• z <br /> Boring# Boring q q ' �Q <br /> Pit Ground surface elev.! /_ft. Depth to limiting factor —in. <br /> Soil Application Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/(f <br /> in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. •Eff#1 'Eff#2 <br /> I 0-s 4L <br /> Z -41 7--fLtA 4 �� Nb a I 2.C'0 ,1 I.2 <br /> Effluent#1 -BOD >30:<220 mg1L and TSS>30 1150 mg/L •Effluent#2=BOD,:5 30 mg/L and TSS<30 mg/L <br /> CST (Please Print) Signature CST Number <br /> u et 2756 <br /> Addresk Date Evaluation Conducted Telephone Number <br />