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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 <br /> Attach complete site plan on paper not less than 8 1/2 x 11 inches in size.Plan must County <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. 057- 52�{p 0& 10 <br /> Please print all information. Reviewed b Date <br /> Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). q--�—� <br /> Property Owner Property location <br /> 1.n ppazolIANGovt.Lott 1/4 1/4 S Z T44 N R E(or W <br /> Property Owner's Mailing Address Lot# B1o1c A Subd, Nam or CSM# <br /> 204 R <br /> city S to zip code Plilone Number ❑City ❑Village own Nearest Road <br /> n4 IZV I 493p I ( ) 1 SD1114 4 <br /> ❑ New Construction Use Residential/Number of bedrooms _ Code derived design flow rate 490 GPD <br /> Replacement ❑ Public or commercial-Describe: <br /> Parent material �,R'Fr Flood Plain elevation if applicable _ --- ft. <br /> General comments <br /> and recommendations: <br /> Sys. . 01 $ <br /> F <br /> Boring# Boring <br /> pit Ground surface elev. q2.7 ft. Depth to limiting factor 7 2 _in. <br /> Soil Application Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDlff <br /> in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. •Eff#1 I •Eff#2 <br /> .4 / z <br /> 7 <br /> Boring# Boring <br /> ❑ Pit Ground surface elev.�S'� ft. Depth to limiting factor��-in. <br /> Soil Application Rate <br /> Horizon I Depth I Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM <br /> In. Munsell Qu.Sz. Cont Color Gr.Sz.Sh. •Eff#1 •Eff#2 <br /> 110- 6— -7473/ s /•z <br /> Z •61 j <br /> 3 6rllb 7 s s .7 /. Z <br /> Effluent#1 =BOD >30:<220 mg/L and TSS>30<150 mg/L •Effluent#2=BOD <30 mg/L and TSS<30 mg/L <br /> CST me (Please Print) Signature CST Number <br /> S <br /> Addlilass Date Evaluation Conducted Telephone Number <br /> 2a-760 35r 4meW1. M513 9.1 - ©0 1S <br /> L Uc.,�ot 5� B b'•9 <br />