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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 /> Attach complete site papa County <br /> plat plan on r 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 p <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. Vr O /oto <br /> Please print all information. Reviewed by Date <br /> Personal information you provide may be used for secondary purposes(Privacy Law,a.15.04(1)(m)). <br /> Property Owner Property Location <br /> -P—r' Govt.Lot 1/4 1/4 S?y T elCl N R /S E( W <br /> Property Owner's Mailing Address 1 Lot# Block# Subd.Name or CSMA <br /> Tr — S <br /> City / State zip Code Phoria Number ❑city ❑Village Wown Nearest Road <br /> ❑ New Construction Use:21.Residential/Numbar of bedrooms- ` _ Code derived design flow rate GPD <br /> 52FReplacement C3Public or commercial-Describe: <br /> Parent material Flood Plain elevation if applicable IAU4= ft. <br /> General comments <br /> and recommendation: pr/�'� p[ rock *-�nA <br /> 9 <br /> /hop.a.ti/ss�,.J d <br /> Boring Al ❑ Boring <br /> Pit Ground surface elev. i O 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 /> �;."'VAok <br /> , <br /> aa �# ❑�y Boring (�' <br /> I&Pit Ground surface elev.+r-f—ft. Depth to limiting factor�0� in. <br /> Soil Applicatiort Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Conmtence Boundary Rods GPD/ff <br /> In. Munsell Clu.Sz. Cont.Color Gr.Sz.Sh. •Eff#1 •Etf#2 <br /> 7' <br /> 7- — <br /> r <br /> Effluent#1 =BOD >30 220 mg(L and TSS>30:!_150 mg/L •Effluent#2=BOD 130 nxyL and TSS 130 mg(L <br /> CST Name Print) _ Signature CST Number <br /> Address r Date Evaluation Conducted Telephone Number <br />