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Wisconsin Department of Commerce SOIL EVALUATION REPORT Page I of,� <br /> Division of Safety and Buildings <br /> in accordance with Comm 85,Wis. Adm. Code <br /> Canty Ur/12'(t <br /> Attach complete site plan on paper rat less than 81/2 x 11 inches in size.Plan must <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. <br /> Please print all information. Reviewed by Date <br /> Pereonal informdon you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). <br /> it OL <br /> Property Owner Property Location <br /> Jerr /�or%Obeek GovLLot NE 1/4SW 1/aS3.6 Tyo N R /S E(or)® <br /> Property Owner's Mailing Address Lot# I Bleck# I Subd.Name or CSM# <br /> 17988 WrIJ Iht (?off 3 VA PA17 P'erep v.3 P `)s <br /> city State Zip Code Phone Number LlCity ❑Village ®Town Nearest Road <br /> % ors r'q,(tf ,A) SSOI?4 (65'1 )S-gS-dyo/ .Jackson <br /> /Y1wllarol L/t KOCA' <br /> �$ New Construction Use:® Residential/Number of bedrooms d Code derived design flow rate 3 0 o GPD <br /> ❑Replacement ❑ Public or commercial-Describe: <br /> Parent material Gds c r a! i tr* Flood Plain elevation If applicable <br /> R <br /> General comments \ <br /> and recommendations: SX r• Q /P u, q I,LO(o 93. 0 <br /> Bodng# ❑ Boring <br /> ® Pit Ground surface elev. 9 ' L( ft. Depth to limiting factor ? 7 d in. <br /> Soil Application Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF <br /> in. I Munsell Qu.Sz. Cont Cola Gr.Sz.Sh. •Eff#1 •Eff#2 <br /> 7.5rRJ/d I /ire <br /> <1 3- 4d 7,SYR4/6 /3 /m:rbk r" GS <br /> 3 yi,-to07.5' }/? Y/4 IS Jwis6k , rt 6S dF . 7 /. 6 <br /> y b0-7) 7.S rR s'/ — s o s c ) - - 7 /. 6 <br /> ` Boring# ❑ Boring <br /> ® Pit Ground surface elev. 49.8 ft. Depth to limiting factor > 78 <br /> 0.Tin. <br /> Soil Application Rate <br /> Horizon I Depth Dominant Cola Redox Description Texture Structure Consistence Boundary Roots GPD/W <br /> In. Munsell Ou.Sz. Cont.Color Gr.Sz.Sh. •Eff#1 I •Eff#2 <br /> d 3- Yb 7.S'rR 11/6 i3 /r.13bk .1.1 ( GS 3m -7 /. 6 <br /> 7-Cir)Y Y'4 — IS Iw1A6 k VA 7 <br /> •Effluent#1 =BOD >30<220 nVL and TSS>30 1150 mg1L •Effluent#2=BOD <30 mg&and TSS<30 mg1L <br /> NNW CST Ne (Please Print) - SignatureCST Number <br /> �4a1 4j s s, Gla I Q (s S i)4� -" of 73 4d a <br /> Address IDate Evaluation Conducted Telephone Number <br /> A'77e- J'1-a- L✓Z 1Y373 r,k- J.7- 66 715= -7 <br />