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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 <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. 1 ^ <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. s-.�v <br /> Please print all information. Reviewed by A Dat <br /> Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). t/r �'/ <br /> Property Owner Property Location <br /> Govt.Lot 2 1/4 1/4 S T N R E(o W <br /> Pfopdrty Owner's Mailing Address Lot# Block# I Subd.Name or CSW <br /> E _ IV.ial _ Z 1 1 V. _ 16 <br /> City State Zip Code Phone Number ❑City ❑Village own Nearest Road <br /> 4155 (612) - LA <br /> New Construction Lse:C3Residential/Number of bedrooms _ Code derived design flow rate __ GPD <br /> ❑Replacement ❑ Public or commercial-Describe: <br /> Parent material 02a -- Flood Plain elevation if applicable ft. <br /> General comments or <br /> and recommendations: /,� 9f, 7 <br /> �- Cf�tL 9�•�' <br /> ❑ Boring# ❑ Boring -q-- 73 <br /> Pit Ground surface elev. ft. Depth to limiting factor > —in. <br /> Soil Application Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/f? <br /> in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. "Eff#1 'Eff#2 <br /> I <br /> 0-5 7•s R3 rt— /S OS I S 2_to . 7 <br /> S-32 7.5VR 419 A15 as /hf 95 '1 r c ' -7 /.z <br /> 3 <br /> 32-73 7.5%.94 M s os r, n^ 1 / . -7 /,-Z, <br /> —+7 <br /> Boring# ❑ Boring /� <br /> 0 Pit Ground surface elev.�9. ft. Depth to limiting factor,__in. <br /> Soil Application Rate <br /> Horizon Depth Dominant Cdtx Redox Description Texture Structure Consistence Boundary Roots GPD/fF <br /> in. Munsell Qu.Sz. Cont.Cola Gr.Sz.Sh. 'Eff#1 'Eff#2 <br /> 1 3 7:s len -7 <br /> Z -43 7W 4. A< / 4S /ca J AZ <br /> se. <br /> Effluent#1 =BOD >30<220 mg/L and TSS>30<150 mg& 'Effluent#2=BOD 130 mg/L and TSS 130 mg/L <br /> CST (Please Print) - _ Signature CST Number <br /> 225851 <br /> Date Evaluation Conducted Telephone Number <br /> 2_7716ap i0w,46 W1 • 12 S <br />