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Wisconsin Department of Commerce SOIL EVALUATION REPORT Page / of 7 <br /> Division of Safety and Buildings <br /> in accordance with Comm 85,Wis. Adm. Code nn <br /> Attach complete site plan on paper not less than 8112 x 11 inches in size.Plan must County <br /> include,but not limited to:vertical and horizontal reference point(BM),direction and Parcel I.D. D 7 Od.O A O / 3 <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. O zr- O/d o 00 <br /> Please Print all information. Reviewed by Date <br /> Personal information yw provide my be used for secondary purposes(Privacy Law,s.15.04(1)(m)). <br /> Property <br /> �Owner Property Location <br /> VA., Govt Lot 1/4 1/4 S 33 T c/O N R //o <br /> (or& <br /> Property Owner's Mailing Address Lot# Block# Subd. Name or CSW <br /> SINS (frtenhwvc I'r. d ,Z <br /> cityState Zip Code Phone Number ❑City []Village ®Town Nearest Road e47 0H <br /> !/adaH;s I/rr✓ Ss/a7 <br /> ® New Construction Use:® Residential/Number of bedrooms 0— Code derived design flow rate 00 GPD <br /> ❑Replacement ❑ Public or commercial-Describe: <br /> Parent material G/eL/.1 a / 0r tilt` Flood Plain elevation if applicable ft. <br /> General comments <br /> and recommendations: syr' e/sem' <br /> Mo/W as AIRA 4ia t 4,dowY 5&,vf 303 6 fit' e.+•E d <br /> © Boring# ❑ Boring <br /> ® Pit Ground surface elev. 95'O ft. Depth to limiting factor 7740 in. <br /> Soil Applicatim Rate <br /> Horizon I Depth I Dominant Color Redox Desorption Texture StructureConsistence Boundary Roots GPD <br /> in. Munsell Ou.Sz. Cont Colo Gr.Sz.Sh. I `Eff#1 I 'Eff#2 <br /> /s /Ms6/c ,n I cs a, .-7 6 <br /> was 7.syAy/y — /S ,Z.nsb/c ml GS 3cc 7 6 <br /> 3 As-39 S7r? b/[ , , / Z a4.yl . 7 6 <br /> 3Y-SY 7. s 717`//y S/6r D 5 6 in l GS - • 7 1116 <br /> �l 9-7G <br /> Boring# ❑ Boring <br /> ® Pit Ground surfaceelev. 9`S' 3 ft. Depth to limiting factor 7 in. Soil li n Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/10 <br /> in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. `Eff#1 Ei <br /> / O—c/ 7SY/?310- /S /insb/� r+ l GS 3�n "7 A 6 <br /> 7.S7/7 %y — / S ,1.. s6/� I GS 3co6 <br /> S r✓r / S M -7 <br /> GS - -7 X6 <br /> -7 <br /> `Effluent#1 =BOD >30<220 rrmglL,and TSS>30<150 rnglL 'Effluent#2=BOD <30 nxyL,and TSS<30 rnglL <br /> CST Name(Please Prim) SignatureCST Number <br /> Address <br /> .Jame-s 541,71ea/S 7.34Ja <br /> Date Evaluation Conducted Td <br /> ' ephone Numbei <br />