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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 minty <br /> Attach complete site plan on paper not less than 8112 x 11 inches in size.Plan must Qk rn e t I` <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. Q —S 19-G-T"60 <br /> Please print all information. Review y Date <br /> Personal information you provide may be used for secondary purposes(Privacy law,s.15.04(1)(m)). <br /> Property Owner Property Location <br /> W 11A0 M 0Isom Govt.Lot I 1/4 1/4 S /`) T Sl/ N R/S E(or& <br /> Property Owners Mailing Address Lot# Block# I Subd.Name or CSW <br /> 897 d /a tk st. W. <br /> City State Zip Code Phone Number ❑City ❑Village ®Town Nearest Road <br /> Lake v;l(e WAI 1 Ssa Yy I ( I (3✓a o(sGcir✓ V. <br /> ❑ New Construction Use:[H Residential/Number of bedrooms Code derived design flow rate 300 GPD <br /> ❑Replacement ❑ Public or commercial-Describe: <br /> Parent material G/a c/a / C7r%Fr Flood Plain elevation if applicable /Ulm ft. <br /> General comments <br /> and recommendations: Sys <br /> Boring# <br /> / ® Boring <br /> a <br /> ❑ pit Ground surface elev. Q7. 3 ft. Depth to limiting factor in. �I 'cation 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 /> 3 <br /> �f 60 Sti 7-'r Yn <br /> Boring# ❑ Baring <br /> ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil licafion 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 /> Effluent#1 =BOD >30_<220 mglL and TSS>30<150 mg/L 'Effluent#2=BOD <30 mg/L and TSS 130 mg/L <br /> CST Name(Please Print) Signature CST Number <br /> a PA >°s s A r �I S � 734d a <br /> Address Date Evaluation Conducted Telephone Number <br /> 7 7 /Y w l 3� u� W-� I/- 1 3-C2 7/s-5%, -Ul 7 � . <br />