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Wisconsin Department of Commerce SOIL EVALUATION REPORT Page_I of 3 <br /> Division of Safety and Buildings <br /> in accordance with.Comm$5,Wis. Adm. Code p <br /> Attach complete site plan on paper not less than 812 x 11 inches In size.Plan n must 6r 02 Sop -Le9 W <br /> Include,but not limited to:vertical and horizontal reference point(BM),direction and pg� IA. 5122 <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. O 7 01d}40 16'}M f o y 000 O 114,0 0 <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)). II•-1�L <br /> Property Owner p Property Location <br /> h i 05 GovL Lot s 114 NE 1/4 S ri 11 T 1710 N R /S E(Or& <br /> Property Owners Mailing Address Lot# Bbdc# Su W.Name or CSIM <br /> �S 3 9'3 /7hcr.1 <br /> City State Zip Code Phone Number ❑City ❑Village ®Town Nearest Road <br /> wd.6re.� I w.r 1 SNS93 1 ( 04G- 7S`/7 '�ro"re of/r oAer. /Zi(• <br /> ❑ New Construction Use:® Residential/Number of bedrooms 3 Code derived design flow rate ys'O GPD <br /> ®Replacement ❑ Public or commercial-Describe: <br /> Parent material r'!a c i / ,c7 r%F* Flood Plain elevation N applicable /y/p ft <br /> General comments <br /> and recommendations: Sys /,f v. 9/, 90 �e 93. 70) ej <br /> a cd as 439 G - Gan -a 6A)A " <br /> F Boring# ❑ Boring p u -7 <br /> ® Pit Ground surface elev. 9 y 7 R. Depth to limiting factor > 7a 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 /> / 0- y 7.r y 2 J/f /S /in 6/< ,.,-, I 43 7A" , 7 /• d- <br /> 7.S-v M <br /> .s-vR y/6 — / S „-,s6/e rr t 6 s yea -7 1- 6 <br /> 3 /d-dl '7.3'YR eA. S'6A_ „f l 6 5 a nt 7 /, 6 <br /> �! l- so7's-e2 `'/y S os6 I GS - 7 46 <br /> 5 sa- 7l 7.s r/?% S os< Nn I — — 7 !, 6 <br /> Boring# ❑ Boring <br /> 0 Pit Ground surface elev. 96. 4 ft. Depth to limiting factor > 9Y in. <br /> Soil licetion Rate <br /> Horizon Depth Dominant Cola Redox Description Texture Stnxlure Consistence Boundary Roots GPD/ff <br /> in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 'Eff#2 <br /> >.ryA3/,, — /s -4 61e . 7 /. to <br /> d 9-dH 7._r /Z 1 — /s at ns6/e ! �. S Sea 7 /16 <br /> 3 ay- yb 7.S-IR y�e/ — S os0 7 1. 4 <br /> 'Effluent#1 =BOD >30<220 mg1L and TSS>30 1150 mg/L 'Effluent#2=BOD <30 mg&and TSS<30 rtg& <br /> CST Name(Phrase Print) - Signature CST Nurber <br /> �me.s dt 7-f9)0 <br /> Address U Date Evaluation Conducted Telephone Number <br /> eA77(oofi4,.. 3s Gc�eGs14� r,_1•-- .5'4g- 7— 7— <br />