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Wisconsin Department of Commerce SOIL EVALUATION REPORT Paget of <br /> of 3 <br /> Division of Safety and Buildings <br /> in accordance with Comm 85,Wis. Adm. Code <br /> County <br /> Attach complete site plan on paper not less than 8 1/2 x 11 inches in size.Plan must <br /> include,but not limited to:vertical and horizontal reference point(BM),direction and Parcel I.D. <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. <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 /> Property Owner Property Location L <br /> r//4-R/ S w s O r✓ Govt.Lot NC 1/4/1)&1/4 S/c/ T3 N R E(or)§ <br /> Property Owner's Mailing Address Lot# Block# 8"I; +lertfe or CSM# <br /> w 30 .E i�L/ 7d y `— V17 39 - y/ <br /> City State Zip Code Phone Number ❑City ❑village O-To n Nea est Road <br /> Edo o.v e- <br /> $-New <br /> ew Construction Use:21:-Residential/Number of bedrooms 2 Code derived design flow rate _.J O GPD <br /> ❑Replacement ❑ Public or commercial-Describe: �- <br /> C3 ' {� Flood Plain elevation if applicable <br /> �'C.i/� ft• <br /> Parent material � �ft C i/-/- � pp <br /> General comments <br /> and recommendations: <br /> Boring# F1 Boring <br /> Pit Ground surface elev. 2 7 7/7 <br /> ft. Depth to limiting factor ,&l in. <br /> Soil Application Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz <br /> in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. *Eff#1 I *Eff#2 <br /> ❑ Boring# ❑ Boring ' � <br /> 91 Pit Ground surface elev. ft. Depth to limiting factor �>75 in. <br /> Soil Application Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz <br /> in. Munsell Qu.Sz. Cont.Color Gr.Sz. Sh. *Eff#1 *Eff#2 <br /> /127 w i >' Z <br /> *Effluent#1 =BOD5>30<220 mg/L and TSS>30_<150 mg/L *Effluent#2=BOD5<30 mg/L and TSS<30 mg/L <br /> CST Na,/me(Please Pri t) Signature CST Numbeerr, <br /> 4C4 t� �,p �l .sem2 7 <br /> Address Date Evaluation Conducted Telephone Number <br /> SBD-8330(R07/00) <br />