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Wisconsin Department of Commerce SOIL EVALLIATIOPQEPOPCf I N A 1. <br /> Division of Safety and Buildings Page _of <br /> in accordance with Comm 85,Wis. Adm. Code <br /> P1415T <br /> Attach complete site plan on paper not les County �^wvvvLLlllL 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 // information. Reviewed by Date / <br /> Personal information you provide may be used or secondary purposes(Privacy Law,s.15.04(1)(m)). / <br /> PropertyOwner <br /> c■�/� Property Location / ((( <br /> K'+` ✓/�/ttu- Govt.Lot $ 1/4 1/4 S '( T40 N R E(or nW <br /> Propertyne s Mailing dress Lot# Block# Subd. Name or CSM# <br /> rod 3 I NED'A! 5r_ A/.k/. � V. 4 _ _ 46 <br /> City State Zip Code one Number ❑City ❑Village own Nearest Road <br /> ANok1i M�✓ 5530 c ) _ucso►J ISiJCEa <br /> ❑ New Construction Use: Residential f Number of bedrooms-7--- Code derived design Flow rate 14-10 GPD <br /> Replacement C3 Public or commercial-Describe: GPD <br /> — <br /> Parent material 11}G l <br /> General comments D _ Flood Plain elevation if applicable ryF+ <br /> ft. <br /> and recommendations: <br /> Sys_ /off., 3 <br /> ' Boring# Xd'11 Boring? Pit Ground surfa elev.101--1/� <br /> ft, Depth to limiting factor 4-5 —in. <br /> Soil Application Rate <br /> Horizon Depth Dominant Color R ox Description Texture SWcture Consistence Boundary Roots GPD/ff <br /> in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 •Eff#2 <br /> A4 ge <br /> All <br /> Boring# 'KBoring 2 2Q <br /> Pit Ground surfaceelev. /03. 3 ft. Depth to limiting factor / 1 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 /> Af <br /> t /s <br /> s <br /> 4 G s <br /> Effluent#1 =BOD >30:<220 L and TSS>30<ISO mg/L Effluent#2=BOD,:<30 mg/L and TSS<30 mg/L <br /> CST Na (Please Print) �Si nature CST Number <br /> f 2.2,5'8SI <br /> 'iress Date Evaluation Conducted Telephone Number <br /> !Znko Aty 3S3rQ? WI- 59�9� 3- 31- o1 7l5 OCCIV 41s7 <br />