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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 pighm <br /> Attach complete site plan on paper not less than 8 1/2 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 /> Personal information you provide may be used for secondary purposes(Privacy Law,S.15.04(1)(m)). <br /> Property Owner Property Location �/ <br /> Govt.Lot 1/4 1/4 SG�1- / T40 N R E(o W <br /> Property Owner's thiling Address Lot Block# Subd. Name or CSW <br /> 5341 t <br /> City State Zip Code Phone Number ❑City ❑Village 14Town Nearest Road <br /> fL W 1 54893 (� s) O �ycs J k ►21�_ <br /> IR New Construction Use:'® Residential I Number of bedrooms _— Code derived design flow rate Aw GPD <br /> ❑Replacement C1 Public <br /> blicor commercial-Describe: --- <br /> Parent material 4�NV- D r� _ Flood Plain elevation if applicable —AA— ft <br /> General comments <br /> and recommendations: <br /> Boring <br /> ❑ <br /> Boring# Ground surface e /�elev. R� ft. Depth to limiting factor.. •'/ <br /> S in. <br /> pit Soilplication 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 'Etf#2 <br /> 0-// 7• Ar✓�r S U .-7 �•z <br /> 2 it-Zg A ? <br /> 6 5 �►✓ r .z i. i <br /> 49-75 <br /> Boring# Boring Q� d <br /> .yam pit Ground surface elev.1n• T ft. Depth to limiting factor _in. Soil Application Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff <br /> In <br /> Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. Eff#1 -Eff#2 <br /> 1 - <br /> AIV4 s <br /> 2 4 bI Atfy 2 <br /> Jw . /.Z <br /> Effluent#1 =BOD >30:S 220 mg/L and TSS>30<150 mg/L Effluent#2=BOD,:<30 mg/L and TSS<30 mg/L <br /> CST (Please Print) ignature CST Number <br /> ul ! - Z2S'S51 <br /> Addre Date Evaluation Conducted Telephone Number / <br /> 27760 �S W ST W 1. 59�9� ,d �IS 611-6-44s <br />