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Wisconsin Department of Commerce SOIL EVALUATION REPORT Page_ I of 3 <br /> Division of Safety and Buildings <br /> in accordance with Comm tis,Wis. Adm. Code <br /> County <br /> Attach complete site plan on paper not less than 81/2 x 11 inches in size.Plan must <br /> include,but not limited to:vertical and horizontal reference point(BM),direction and Parcel I.D. J <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. LD- Dag <br /> ���g—�� {� ryV <br /> Please print all information. Reviewed Date <br /> Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). <br /> ProOwner / +// ^ Property location r l <br /> ,4 rr fes' ✓ `4-54k Govt.Lot (tf 1/45 W 1/4 S e T Yd N R �Y E(or)(6� <br /> Property Owners ailing AddressLot# Bbdc# Sab&-Name or CSM# <br /> ew 9 63 oTos �,.r, 3 �-- /8 <br /> City State Zip Code Phan Number ❑city ❑Villa 1-Town Nearest Road <br /> GfJe �ke c.J.T ( ) �/ S� o Lo^ <br /> 5g-New Construction Use esidential/Number of bedrooms Code derived design flow rate GPD <br /> ❑Replacement ❑ Public or commgrci*-Describe: <br /> Parent material <31-4; G e;4- / C3( r,_ 14 f Flood Plain elevation if applicable ft. <br /> General comments <br /> and recommendations: ,5�nn d• 9io•I Ea 94. 92 <br /> 171 51 Boring# ❑ Boring <br /> Pit Ground surface elev. C ft. Depth to limiting factor b r'in. <br /> Soil Application Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM <br /> in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. •Eff#1 •Eff#2 <br /> 0-4 MP3 -- / -Ir G S 3fc-& /i <br /> ❑7 Boring# E] Boring <br /> d` P pit Ground surface elev.,27,y ft. Depth to limiting factor O O in. <br /> Soil Application Rate <br /> Horizon Depth Dominant Color Redox Description Texture0Sz. <br /> Consistence Boundary Roots GPD/ff <br /> in. Munsell Qu.Sz. Cont.Color 'Eff#1 'Eff#2 <br /> d- l CS o .� <br /> Effluent#1 =BOD >30:5 220 mg/L and TSS>30<150 mg/L •Effluent#2=BOD <30 mg/L and TSS<30 mg/L <br /> CST Name(Please Print) Signature CST Number <br /> d-e- Ru ySAlAlo t Gr/ -zZ-7d <br /> Address Date Evaluation Conducted Telephone Number <br /> te cs - .s- 41 s'�r erte✓ 3- y7� 3 �Y �y�-2 M.9 <br />