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Wisconsin Department of Commerce SOIL EVALUATION REPORT Page t 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 Ru✓n e 14* <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 b� Date <br /> Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). 6��/ 1�� OW <br /> Property Owner/ pp Property Location <br /> SCtt4.1 GU 0, 9I'a✓G(O Govt. Lot 1VW 110ii'll 1/4 S 30 T 40 N R /7 E(or)e <br /> Property Owner's Mailing Address Lot# Block# Subd.Name or CSM# <br /> 780 /3a;(C Q,, �inewoa� /4htat,al <br /> City State Zip Code Phone Number ❑City ❑Village ®Town Nearest Road <br /> iE-den toes^-se I ;4w I$'S"3 4'7 1 (7.5'01) 97`!- 8.t7/ Union 5- 1 fflhl4md Rd <br /> 54 New Construction Use: Residential/Number of bedrooms 3 Code derived design Flow rate 4S"0 GPD <br /> ❑Replacement ❑ Public or commercial-Describe: <br /> Parent material GIRt+.r l,7�i Ft" Flood Plain elevation if applicable <br /> General comments <br /> and recommendations: Sof ��� 93. S Qayt 93,8 6v <br /> FTIBoring# ❑ Boring <br /> ® pit Ground surface elev. 96• Q ft. Depth to limiting factor 1 7Y in. <br /> Soil Application Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' <br /> in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 'Eff#2 <br /> a-s -7.sra311, i3 0 •7 /. 6 <br /> } S 43 , 5-M '/y !s s l GS 3F , 7 /, 6 <br /> • 7 1. 6 <br /> ® Boring# ❑ Boring pit pit Ground surface elev. 97 g ft. Depth to limiting factor 7 e!/ in. <br /> Soil Application Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' <br /> in. Munsell Cu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 I 'Eff#2 <br /> 1 <br /> 4 --4- -,,.s 1.5 0 c s ?� . 7 /. 6 <br /> ,2 S-YO z 5- `/g — /s o I G S f . 7 /. 6 <br /> /I l: <br /> 'EfFlue it#1 =BODS>30<220 mg/L and TSS>30_<150 mg/L `Effluent#2=BODS<30 mg/L and TSS<30 mg/L <br /> CST Name(Please Print) Signature 0 CST Number <br /> 04 5,0c, v� -735'40 <br /> Address Date Evaluation Conducted Telephone Number <br /> 1776a t/. 3S trl-e r wT- S-40g3 7iS-RG6-Sv,517 <br /> SBD-8330(RO7/00) <br />