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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 plan on paper not less than 8 1/2 x 11 inches in size.Plan must County Q u r•n e 7t' <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. / y e( 03 )-00- <br /> Please print all information. Reviewed Data / <br /> Personal information you provide maybe used for secondary purposes(Privacy Law,s.15.04(1)(m)). —o <br /> Property Owner y-- Property Location <br /> X� / 0#1 Sa er Govt.Lot SP PW114.5W 1/4 S3S T4/0 N R /5- E(or <br /> Property Owner's Mailing Address Lot# Block# &6d.Name or CSM# <br /> ,I,l 3 / (f l i FFv,ery Lir. I --Srr U. /9 P, //6 <br /> City StateZip Code Phone Number ❑City ❑VIIlage (n Town Nearest Road <br /> E6A n 1 0/f/ I .ff/ov (6 r/) (o 9'8-OS-13 .Ja e kOt7 074 Ad <br /> 0 New Construction Use:❑ Residential/Number of bedrooms_�__ Code derived design flow rate 3Oa _GPD <br /> ❑Replacement ❑ Public or commercial-Describe: _ <br /> Parent material (r-14CIAl Flood Plain elevation if applicable _ ft. <br /> General comments <br /> and recommendations:C a Co+ o u if e/0/*c-a c..� a 4.vc.� ,4.✓ <br /> Qa,q <br /> Boring# ❑ Boring //// <br /> ® pit Ground surface elev. ft. Depth to limiting factor Y—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 /> ( o_4 7,9-9R 3�h /s al '&i/c ( Cs d m . 7 /' d <br /> 1- q-34 -7.Ss 4*/4 AAS OS5 r, / Is _7 fat <br /> ?I-4'0 7,sYq b/ yh S p s ,,, I 9 S 7 AA <br /> y fe-64 7rsYk�/y — fs /Ms6l� M6- 9s s 9 <br /> L4-G9 7,s of kl4 <br /> ® Boring# C] Boring <br /> I� gyp' <br /> L'3 Pit Ground surface elev. y�/ ft. Depth to limiting factor 7-T- 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 /> 0-3 7rSY/f 3/Y — /J / /gf C(I f S J,M , ,7 /. <br /> 3- 96 s OS-5 ,,, 5S / (< 7 / <br /> fol >.S'�f y�� r<s 7� s6/1 vf.- '5— <br /> Effluent#1 -BOD >30<220 mg/L and TSS>30 1150 mg/L 'Effluent#2=BOD 130 mg/L and TSS<30 mg/L <br /> CST Name(Please Print) Signature CST Number <br /> .ne_s Sn/to�-r s� a- >3SVU— <br /> Address Date Evaluation Conducted Telephone Number <br /> ,d. (3 6x 6 ebsfev !�--d.It- d 1 7/r- e66- 70 80 <br />