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dao <br /> NimislosiDepartment ofCommerce SOIL EVALUATIO &-R� NAL <br /> DlvisfOn offSafety and Buildings � Page,_of <br /> in accordance with Comm 85,Wis. Adm. Code [ L <br /> Attach complete site plan on paper not less than 8 1/2 x 11 inches in size.Plan must County <br /> include.but not limited to:vertical and horizontal reference point(BM),direction and <br /> Percent slope,scale or dimensions,north arrow,and location and distance to nearest road. Parcel I.D. <br /> Coo -02 <br /> Please print all information. Reviewed b e <br /> Personal information you provide may be used for secondary purp0ses(Privacy Law,a.15.04(1)(m))• J L/j C ({ <br /> PfopertyOwner 1 CJ`C <br /> Property Location <br /> GovL Lot 3 1/4 1/4 S i(JI T!o✓ N R J E(o <br /> Property Owner s Mailing Address Lot# Block# Subd.Name or CSM# <br /> Gly State Lp Code Phare Number ❑City ❑Village CFTown Nearest Road <br /> MN /Z (45Z ) v _4o�r p C <br /> ® New Construction Use: Residential/Number of bedrooms _ Code derived design flow rate y�J� GPO <br /> ❑Replacement Cl Public or commercial-Describe: <br /> nt <br /> Parematerial 4414e,ZiZ T'// Flood Plain elevation if applicable <br /> General comments <br /> and recommendations: t Y!; FL r 7�'7 <br /> `` 6oy5t-A-i q3.3 <br /> Boring# Boring <br /> Pit Ground surface elev. <br /> _..& Z ft. Depth to limiting factor 771 in. <br /> Soil lication Rate <br /> Horizon Depth Dominant Col Redox Description Texture Structure Consistence Boundary Roots GPDM <br /> in. Munsell Qu.Sz. Cont ColorGr.Sz.Sh. 'EI*1 'E(fir2 <br /> l <br /> 0-/0 7-5- Z e5 Z' 1 s <br /> Z33-64 d 5 � 6 F - S <br /> Yt-Ik r F l MV 5 /F - 5- <br /> 60-71 <br /> -7l t ,C 6 <br /> • s <br /> I <br /> a Boring# ❑ Boring <br /> pit Ground surface elev. 6��ft. Depth to limiting factor 7 70 in. <br /> Soil Ao lication Rate <br /> Horizon Depth Dominant Col Redox Description Texture Structure Consistence Boundary Rcgts GPD,f <br /> in. Munsell Cu.Sz. Cont.Color Gr.Sz.Sh. Eff#1 'Eff#2 <br /> l O-i1 Z•5Y,Q3 --� L / i-rrL �s I <br /> Z <br /> 1-36 ,d 5 L -6 M . 5 <br /> 36 <br /> F Zm vF IF <br /> W -7a ZVVIZk MZ - <br /> i <br /> I ( <br /> _ <br /> Effluent 91 =BOD >30<720 mg/L and TSS>30 150 mg/L Effluent#2=BOO <30 mg/L and TSS<30 mg/L <br /> CST Name (Please Print) Signature CST Number <br /> 0 <br /> Address Date Evaluation Conducted Telephone Number <br /> ZI X60 3 65><ef W. 513 - Y/57 <br />