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Wisconsin Department of Commerce SOIL EVALUATION REPORT Pageof_ <br /> Division of Safety and Buildings <br /> in accordance with Comm 85,Wis. Adm. Code I, <br /> County Div„e-�- <br /> Attach complete site plan on paper not less than B 1/2 x 11 inches in size.Plan must — <br /> inciude,but not limited to:vertical and horizontal reference point(BM),direction and Parcel I.D. Cif cl pOd <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. Oag- (�7S-Q <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 /> PropertyOwnerProperty Location <br /> Ave,/ St e+-;nvr Govt.Lot Siv 1/4 NE 1/4 S 7 T yD N R 14 E(or) <br /> Property Owner's Mailing Address Lqt# Block# Subd.Name or CSW <br /> 03s an tem Ll- rAW-4f 5Md4 . <br /> City State Zip Code Phone Number ❑City ❑Village QTovm Nearest Road <br /> I I{d�: S`Q`a30 (7rS` ) J-S9-360y Scop`' �lan seem Ue 7`,,- , <br /> ❑ New Construction Use:® Residential/Number of bedrooms Code derived design flow rate 4^<0 GPD <br /> ®Replacement ❑ Public or commercial-Describe: <br /> Parent material aG"a( oeiiel Flood Plain elevation if applicable ��/� ft. <br /> General comments Sys. C/.1.. q6.3 <br /> and recommendations: <br /> (3®ter•�f 3� /�,-�Zon 3 ��� <br /> ,�"I:C 1 (het n Ws rrR Y6 <br /> Boring# <br /> Boring <br /> I ® pit Ground surface elev. � 1 ft. Depth to limiting factor .S3 in. <br /> Soil Application Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF <br /> in. Munsell Cru.Sz. Cont.Color Gr.Sz.Sh. •Eff#1 •Eff#2 <br /> l D-4 7,Sr Y JSmss its l cs 160 7 <br /> 'f- yy zrs' "/6 -► � s oS5' h1/ 9s d w, 7 <br /> 3 9g-S3 7,syq 514 ., les ass i,'l ( cs <br /> �l 5`3,ss 7,r5-1 v/ Cid SY,d r/ VI(S <br /> 1 41 1 Boring# ®t Boring <br /> II vim` II l� Pit Ground surface elev.y7i ? ft. Depth to limiting factor S �'g in. <br /> Sal Application Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF <br /> in. Munsell ou.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 'Eff#2 <br /> 4.4 <br /> -7,5t4 9/ ill s ass s` 17 <br /> b� -7. <br /> fj <br /> Effluent#1 =800 >30:S 220 mg/L and TSS>30<150 mg/L Effluent#2=BOD <30 mg/L and TSS:S 30 mg/L <br /> CST Name(Please Print) Signature CST Number <br /> M e . r 5', A73 41 <br /> Address Date Evaluation Conducted Telephone Number <br /> 1.77 e4i- 35- ul eS SI`rr✓ W- -5 g'9 S---7- 0 f -7i 5-- S-6 6- Q15-- <br />