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Wisconsin Department of Commerce SOIL EVRLRl9@1V" Pa <br /> Division of Safety and Buildings 9e_ of <br /> in accordance with Comm 85,Wis. Adm. Code --- <br /> r.4tr <br /> Attach complete site plan on County paper not less than 8 1/2 x 11 inches In size.Plan must &Ig Il <br /> Include,but not limited to:vertical and horizontal reference point(BM),direction and Patel 1. . O O <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. <br /> Please print ell information. Reviewed by Date <br /> Personal information you provide may be used for secondary purposes(Privacy Law,a.15.14(1)(m)). V <br /> Property Owner Property Location <br /> 16OLD Govt.Lot-j- 1/4 1/4 S 3 T 40 N R '� E( W <br /> Property Owner's Mailing Address Lot# Block# I Subd.Name or CSW <br /> lain <br /> 011-1 RK - Su <br /> Ry State 7jp Code Phone Number ❑City ❑Village Wrown Nearest Road <br /> &h - UEPJZ7- <br /> Of <br /> Now Construction UseV Residential/Number of bedrooms _ Code derived design flow rate_ GPD <br /> ❑Replacement ❑ Public or commercial-Describe: <br /> Parent materialFlood Plain elevation if applicable ft. <br /> General comments <br /> and recommendations:` jr- 0 <br /> Boring# Boring �/n <br /> I Pit Ground surface elev. q /.q ft. Depth to limiting factor 79f in. <br /> Sort Application Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIN <br /> in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. n_ •Eff#1 '011112/ <br /> 0-.5 s Ii 4, f i�fJ .7 �•Z <br /> /KfN Mi S Zca •-7 l• <br /> 3 G /113 M <br /> /L Boring# ❑ Boring <br /> 10 Pit Ground surface slev. ft. Depth to limiting factor >SO in. <br /> Soil Application Rate <br /> Horizon Depth Dominant Color Redox Description TexturejSz. <br /> Consistence Boundary Roots GPD/If <br /> In. Munsell Qu.Sz. Cont.Color 'Eff#1 'Eff#2 <br /> Sy - t 1 2co •1 1.2 <br /> Alk SMA ,� ►.Z <br /> Effluent#1=80D >30<220 rtlg/L and TSS>30<150 ng/L •Effluent#2=BOD <30 mgA.and TSS 130 mg/L <br /> CST (Please Print — — Signature — CSTNumber <br /> Ct�J} <br /> Date Evaluation Conducted Telephone Number <br /> 2��6d 9$ )- 3 IS <br />