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4e <br /> 367 pRI <br /> GINS <br /> Wisconsin Department of Commerce SOIL LIATION REPORT Page`_of <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 by Date <br /> Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). <br /> P Owner Property Location <br /> of e7w Govt.Lot 1/45C 1/4 s 'q T 4 N R IL E(olo <br /> Props Owner's Mailing Address Lot# Block# Subd.Name or CSM# <br /> ID <br /> 5 o <br /> City State Zip Code Phone Number ❑City ❑Village 2MTown N rest Road <br /> New Construction User Residential/Number of bedrooms Z _ Code derived design flow rate b GPD <br /> Replacement ❑ Public or commercial-Describe: <br /> Parent material G' t l DJZI}'� _ Flood Plain elevation if applicable ✓'� ft. <br /> General comments <br /> and recommendations: � , ' <br /> GL 7ON' i �/t�i1� ,f0/ I-WIA4 K r1 <br /> Mr <br /> Boring# F] Boring d <br /> I �Pit Ground surface elev._ ft. Depth to limiting factor r 9 _in. <br /> Soil Application Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff <br /> in. I Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 I 'Eff#2 <br /> I - g 17.5,4 a-3 Is ik v 2 -7 ).2 <br /> �L OW S R S IM4 • 7 Z <br /> s vqf .'7 1-7— <br /> • �• S4 s I .7 !•Z <br /> •63fif .5%4R5-19 Ms .z <br /> Wptw Ar 43 <br /> Boring# ❑ Boring r� <br /> pit Ground surface elev.�?ft. Depth to limiting factory-a__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. 'EH#1 'Eff#2 <br /> I r a 3 !s M✓{i- S ':Z --7 <br /> I. z <br /> SAiIiIii 414 lm5we . 7 1. <br /> 3 Z •L4 S n 4 , Ntis Mil .7 1. 2 <br /> •Sn 7 s a wa � — . � <br /> Effluent#1 =BOD >30<220 rrg/L and TSS>30<150 mg& Effluent#2=BOD _ m and T L <br /> CST (Please Print) Signature CST Number <br /> 22-$-51 <br /> AddreA I valte Evaluation Conducted Telephone Number <br /> 2776° bAbv&j? 6- 19-o-7- 76 &6-467 <br />