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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 /> County <br /> Attach complete site plan on paper not less than 8 1/2 x 11 inches in size.Plan must hAekl9m <br /> include,but not limited to:vertical and horizontal reference point(BM),direction and Parcel I.D. �1 <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. 02-0 4302 03 ZOO <br /> Please print all information. Reviewed by Dated w <br /> Personal information you provide maybe used for secondary purposes(Privacy Law,s.15.04(1)(m)). yr/ <br /> � <br /> Property Owner Property Location / v <br /> Is./`ij•1 Govt.Lots 1/4 1/4 S X T 4t N R I(p E(or <br /> Prop—e #Owners Mailing Address Lot# Block Subd. Name or CSM# <br /> 3 g7 � —CGRCR 2 oliC Lo-r3 <br /> City State Zip Code Phone Number ❑City ❑Village 25Town Nearest Road <br /> -D`44bua W1 j54S3o 1 ( (S ) GSZr 31 Rn- <br /> ❑ New Construction User Residential/Number of bedrooms�_ Code derived design flow rate_�SD GPD <br /> Replacement n ❑ Public or commercial-Describe: <br /> Parent material &Alto/AL J291/7 Flood Plain elevation if applicable ft. <br /> General comments <br /> and recommendations: <br /> > <br /> 'a Boring <br /> F-ilBoring# p <br /> ❑ pit Ground surface elev. /S 4 ft. Depth to limiting factor 1 9_in. <br /> Soil Application Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPr)tw <br /> in. Munsell Ou.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 •Eff#2 <br /> I S� z Is �► I.z <br /> 3 'l.S K 4 r,s J 1. 2 <br /> Boring# ❑ Boring p �7 <br /> Ypit Ground surface elev. 8- I ft. Depth to limiting factor 7 dS 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 /> I b-$ 7• 3z 15 h�� S �v� "7 2 <br /> Z g- �o Ms S I nil S .? <br /> 3 SD-los 7 /. Z <br /> •Effluent#1 =BOD >30<220 mg/L and TSS>30<150 mg/L •Effluent#2=BOD,:s 30 mg/L and TSS:S 30 mg/L <br /> CST Narr&(Please Print) Signature CST Number <br /> KMAW &glwe225rSS7 <br /> AddresS I I Date Evaluation ConductedTelephone Number <br /> 27760 �S (,tlj1f2 W I. S�$93 q -3-0Z 715 $66-457 <br />