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Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of 3 <br /> Division of Safety and Buildings <br /> in accordance with Comm 85,Ws. Adm. Code <br /> Br <br /> Attach complete site plan on paper not less than 8 112 x 11 inches in size.Plan must County 7-11, <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. 6-32-5,;96—No-7co <br /> Please print all information. Reviewed Date <br /> Personal information you provide may be used for secondary purposes(Privacy Law,s.15.D4(1)(m)). , i Jul— 07 <br /> Property Owner Property Location <br /> 6rC 1;/lgr Govt.Lot 3 1/4 114 $A b T y/ N R /5' E(or)N <br /> Property Owner's Mailing Address Lot# Block#TSubd.Name or CSM# <br /> s!Sa se)Qf,/ e.,< 1+3, 1 1 Csm V.au I <br /> City State Zip Code Phone Number ❑City ❑Village g 01 Town Nearest Road <br /> Forest Lk 11nN I SroAS ( ) SA/as A-44 ,FP <br /> ® New Construction Use:® Residential/Number of bedrooms � Code derived design flow rate 300 GPD <br /> ❑Replacement ❑ Public or commercial-Describe: <br /> Parent material G/44%a/ 40,' " Flood Plain elevation if applicable yf� ft. <br /> General comments <br /> and recommendations: Sys• Q/e t/. 90. 0 s9.90 to 93.UC;) <br /> Boring# Boring <br /> Pit Ground surface elev. 96•oZ ft. Depth to limiting factor>pat in. <br /> Soil Application Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/iF <br /> in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 'Eff#2 <br /> / <br /> 6-3 7Ss^R�'� — /s lors6/< A. Cs SM . 7 /• 6 <br /> A 7- 36 7. S O m ! G S 3 e . 7 1. 6 <br /> 3 36- s-4 7.Sy/t 4/F — s o d •h . 7 1. 6 <br /> V/- /a >.$-4 R . 7 / 6 <br /> Boring# Boring <br /> ® pit Ground surface elev. 9y' 8 ft. Depth to limiting factor 7 in. <br /> Soil Application Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF <br /> in. Munsell Cu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 'Etf#2 <br /> 0-3 7.S1/? 3/" . 7 1. 6 <br /> d 3- 3x 7sY/7 3e(,;, . 7 /, 6 <br /> 3 3,t- ro 7.s 1/7' % — s o ,M / G S A -7 /. 6 <br /> 7 A6 <br /> Effluent#1 =BOD >30:<220 mg1L and TSS>30<150 mg/L •Effluent#2=BOD <30 mg/L and TSS<30 mg/L <br /> CST Name(Please Print) Signature n CST Number <br /> Jta rvr -.S S S ✓ 'A 734vo <br /> Address Date Evaluation Conducted Telephone Number <br /> 7760 llty 3S k/e 6stry w S-- 7/r- 86�- /s7 <br />