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ORIGINAL <br /> Wisconsin Department of Commerce SOIL EVALUATION REPORT page I of .3 <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 81/2 x 11 inches in size.Plan must County Our n e�P <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. 036- 4/N/3 - D b 7eV <br /> Please print all information. Reviewed Date <br /> Personal information you provide maybe used for secondary purposes(Privacy Law,s.15.04(1)(m)). .2 07 <br /> Property Owner Property Location <br /> e .I .Stuh e lC �5TAMWIu PkWlka Govt.Lot -fu-(0 1/4 114 S /3 T .moo N R /7 E(or) <br /> Property Owner's Mailing Address /(o S� ;J/n ( CikGLE Lot# Blodt# Subd.Name or CSM# <+ 6 1999 <br /> �' 4 3 reQ C;r•C FXCEGSlotL, MA) 5533) O I I V. /9 P.4s;I <br /> City State Zip Code Phone Number ❑City ❑Village ©Town Nearest Road !9 <br /> loo mn/ 1 SSy'f$ ( ) (,tn/ovl 160ceer t-ee rr4d <br /> P New Construction Usej@ Residential/Number of bedrooms _ Code derived design flow rate yxy GPD <br /> ❑Replacement ❑ Public or commercial-Describe: <br /> Parent material je,'/st G is Flood Plain elevation if applicable /y1/4 ft. <br /> General comments s eIe✓• upp�.- ce// g/. fo(� ( cj/, S3 {0 9t� 70l <br /> and recommendations: S f / <br /> /owar o�// 90, 7v (9(2,$3-6c 92. -70) <br /> AMPQ dS 3915C - bra ifn5-4not <br /> Boring# Boring <br /> ® pit Ground surface elev. 9f 7 ft. Depth to limiting factor 86 in. <br /> Soil lication Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fP <br /> in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 •Eff#2 <br /> / o- N 7-4"?R 3/ — / s /M.O6a M / cs 3"n . 7 1. 6 <br /> d v-.s-6 7syt7V/,, — .S R"-f46/c / Gs 3ca . 7 /. 6 <br /> 3 S'k 7-'r'f - s osell 16 <br /> 71 Boring# ❑ Boring <br /> ® pit Ground surface elev. 93. 7 ft. Depth to limiting factor 7�/ 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 /> / D- I/ 7.SY/7 G1 Sin 7 I to <br /> fr 7 s`'r/�`//y — / s ,1..,�6k ,., 1 G S . 7 1. 6 <br /> -3 S- Al 7SYi? �y — S OS 6 / I -- — . 7 /, 6 <br /> Effluent#1 =BOD >30<220 mg/L and TSS>30< 150 mg/L Effluent#2=BOD <30 mg/L and TSS<30 mg/L <br /> CST Name(Please Print) Signature CST Number <br /> Jcirr,es 5 (�anre/S Signature <br /> 73QdD <br /> Address Date Evaluation Conducted Telephone Number <br /> .,4 771aOffw 3S LLlP6s7�wr Zvr .S48s3 '5 o 8 6 Q 7is- 466- 4/S7 <br />