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Wisc nsin Department of Commerce SOIL EVALUATION REPOF Page—Lof <br /> Division of SOety and Buildings <br /> in accordance with Comm 85,Wis. Adm. Code ` <br /> County <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. <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. . <br /> Please print all information. Reviewed Date p <br /> Personal infarnwtion you provide may be used for secondary Purposes(privacy Law,s.15.04(1)(m))- I .03 <br /> Property Owner Property Location <br /> Govt-Lot A/ 1/4 1/4 S 7 T N R E(or)W <br /> Propertv CK 6-es Mailing Address Lot# Block# Subd.Name or CSM# <br /> Ci ^, i State Zip <br /> �Code Phone Number ❑Ci Ilage 19 Town Neares cad <br /> p New Consb6tion Use: Residential/Number of bedrooms Code derived design flow rate GPD <br /> JA Replacement ^\ `[❑ �urdal-Describe: <br /> Parent material /l n lLta t\►Yl 1 r. r Flood Plain elevation if applicable ft. <br /> General comments <br /> and reconunendaAOCA"t de><•uitt,7 0), 8 3 { ea 4 <br /> tiwus: SyS,EJP� �SG�f gang <br /> Boring# Boring / <br /> ® Pit Ground surface elGv.�L(2Qa�ft. Depth to limiting factorVX G—in. Soil Application Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDMF <br /> In. Munsell qu.Sz Cont.Color Gr.Sz.Sh. •Eff#1 •Eff#2 <br /> ' 7 c <br /> y <br /> • c <br /> 3 <br /> ® Boring# Boring <br /> Pit Ground surface elev. 7,L ft Depth to limiting factor in. <br /> Soil Application Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' <br /> in. Munsell Qy.Sz. Cont.Color Gr. z Sh. •Eff#1 I -Eff#2 <br /> f3- <br /> { 4 rn <br /> Effluent#1 =BOD,>30<220 mg/L afd TSS>3 <150 •Effluent#2=BOD,<30 moll.and TSS<30 mg/L <br /> EAddr <br /> ( Print) S CST Number <br /> a8T_Z57 <br /> Date Evaluation Conducted Telephone Number <br /> � 0 - <br /> ��` �3_QS pan-x11n r mmm <br />