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ORIGINAL <br /> 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 In u J n i <br /> include,but rot limited to:vertical and horizontal reference point(BM),direction and Parcel LD. <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. Q 8pv <br /> Please print all information. Ffeviewed by Date <br /> Personal information you provide may be used for secondary purposes(Privacy Law,a.15.04(1)(m)). <br /> Property Owner Property Location <br /> On le– Der 10 Govt.Lot 5 W 1/4 fv W1/4 S T UQ N R lS E(or) <br /> Property Owners Mailing Address Lot# Block# I Subd. Name or CSM# <br /> 74"Z I W;I/d w W, — --- <br /> City State Zip Code Phone Number ❑City ❑Village [FTown Nearest Road <br /> We'5�1e✓ I U/_! 3``0,3 1 ( 7/5-)S6 - yS63 <-),t e-le:%djol sAor e Rot. <br /> ® New Construction Use:® Residential/Number of bedrooms 3 _ Code derived design flow rate 4S U GPD <br /> ❑Replacement ❑ Public or commercial-Describe: <br /> Parent material Flood Plain elevation if applicable <br /> General commentse <br /> and recommendations: 60 11 //r15'"e',y T to <br /> Y'G'nace rc, lc � P,/1C � �Iefs/ftf y`rn/7F <br /> Boring# ❑ Boring — <br /> ® pit Ground surface elev. 9' ft. Depth to limiting factor > 79 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-6 7,S-" 510L- I /S lm sbl< I C-S 34'0- 7 /10( <br /> 1 6- 34 7.SYR4Xq ^- i"S 055 ml 55 am . 7 !,d <br /> 3 39- `/r' .s-tA "I'q tr..5 OSS m 1 r-S -7 <br /> 'Lf4/-7N 7,syd s/6 -- r»s oS5 rn 1 -96 <br /> Boring# 0 Boring _ <br /> ® Pit Ground surface elev. C15 ft. Depth to limiting factor 7 764 in. <br /> Soil Application Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fl? <br /> In. Munsell Ou.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 I `Eff#2 <br /> l <br /> 6- 6 7.SY/Z 3/ol /S /'M Sb k M I C 5 '3 C 0 1 /,2 <br /> I� 6- Ne 7'-5-V 4� m S O 5Y rn 1 9 S m 7 /,7, <br /> 7, 5Ms/6 Ms ds9 I ss — 1-7 , d� <br /> na Cf� <br /> Effluent#1 =BOD >30:<220 mg/L and TSS>30:E 150 mg/L 'Effluent#2=BOD <30 mg/L and TSS<30 mg/L <br /> CST Name(Please Print) Signature CST Number <br /> Jr►m r -3 -.5 . 0'1 n if is 5 a'0A d- 73 y,40- <br /> Address Date Evaluation Conducted Telephone Number <br /> P-it RaK webSlY.- wr5nve-i,3 4- 1,- 0 14- ti/r- f66- -7(090- <br />