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f <br /> Wisconsin Department of Commerce SOIL EVALUATION REPORT Page_/ of ,3 <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 B 1/2 x 11 inches In size.Plan must county (3urv.ei+ <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. O a 8 q300 0440e> <br /> Please print all information. Reviewed bo� Date <br /> Personal Information you provide my be used for secondary purposes(Privacy Lew,S.15.01(1)(mj). <br /> Property OwnerUG <br /> Property Location '!1 <br /> De Vere Ne/so n Govt.Lot S,6 1/4 1V ItIm S 7 T 40 N R 111 E(or)0 <br /> Property Owners Mailing Address Lot# I Block# I Subd.Name or CSM# <br /> 3o3do G+y I&J. H d <br /> Cdy State Zip Code Phone Number ❑city ❑Villege [$Town Nearest Road <br /> DctnduryWS .V $30 1 (fit/, )B7S- II84 S<ori- j .r}s en :2e—c wa <br /> New Construction Use:® Residential/Number of bedrooms 3 Code derived design flow rate L/ r O GPD <br /> ❑Replacement ❑ Public or commercial-Describe: <br /> Parent material Flood Plain elevation if applicable A-Zly R <br /> General comments <br /> and recommendations: Syr- e /ev y�tr "'50 '6:c' 96M <br /> (atee is 94-50) <br /> Boring# ❑ Boring � '']]�� <br /> ® Pit Ground surface elev. 9 7.0 ft. Depth to limiting factor�—in. <br /> Soil Application Rate <br /> Horizon Depth Dominant Color Redox Desmption Texture Structure Consistence Boundary Roots GPD/1F <br /> in. Munsell Qu.Sz. Cont Color Gr.Sz.Sh. 'Efi#1 I •Eff#2 <br /> l 0.4 '1% — F.- z E <br /> d 4-.r'o I 'V/ Is lmsbk M 1 <br /> • 7 <br /> d Boring# ❑ Boring <br /> ® Pit Ground surface elev. ft. Depth to limiting factor >90 in. <br /> Sal Application Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/1F <br /> In. Munsell Ou.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 I 'Eft#2 <br /> / 0-4 7XVR-V#. — F"re a <br /> -?xm �/G /S /»m S 6 K .,, t G S J.nm 7 /, 6 <br /> 3 94-q7d- <br /> 0 rR 4( S Oso- PAI - - . 7 1. 6 <br /> Effluent#1 =BOD >30<220 mglL and TSS>30<150 mg& 'Effluent#2=BOD,:5 30 mglL and TSS 130 mg/l. <br /> CST Name(Phase Print) - Signature CST Number <br /> Jaenex sO6.h/eLS S OeAvii-eU d73Ydo <br /> Address Date Evaluation Conducted Telephone Number <br /> dt >76 0 /-F•" 3S we bsice wTsN6{ 9,? J�-).7-04 7ts 866 - 4V fS7 <br />