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Wisconsin Department of Commerce SOIL EVALUATION REPOf�T)RIGINA' <br />Division of Safety and Buildings `�+ <br />in accordance with Comm 85, Wis. Adm. Code I� <br />...;unry il/� ✓✓1f <br />Attach complete site plan on paper not less than 8 1/2 z 11 inches in size. Plan must <br />include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.DY40—S" 10,157 - <br />percent slope, scale or dimensions, north arrow, and location and distance to nearest road 0e) Ch %a(f Q O <br />Please print all information. Red <br />Personal information you orovide may oe used for secondary purposes (Privacy Law, s. t 5.04 (1) (m)).Vilt- <br />KUM, <br />IQ-..�S <br />Property Owner i Property Location <br />Govt. Lot 3 114 ,!4 S T y6) N /y <br />! P.rope� btai�� Address ' of » dock # I Subd. Name or CSM# <br />'` Gil 1 ✓• �� /� y `3879 `l 3 <br />City State Zip Code Phone Numeer El City Lld 7 <br />Village XTown Nearest Road 3x70 <br />.�' ! (-71 -) 11/,6 -3.3a 3 <br />New Construction Use: Residential/ Number of bedrooms �' _ Code derived design flow r-te e-+-5-49 <br />GPC <br />Replacement ll ❑ Publiccommercial - Describe: <br />Parent material �/a C l ek /cr� ✓ r' 'K 7- Hoed P!ain elevation if applicable <br />General comments /40-C <br />I and recommendations: % <br />I <br />(� Boring # ❑ Boring <br />® pit Ground surface elev. Depth to limiting fatter i in <br />Horizon <br />0 <br />Depth <br />n. <br />( Dominant Color Redox Description <br />Munsell Qu. Sz. Cont. Color <br />?,SillI4"56'k-- <br />Texture <br />S <br />Structure <br />Gr. Sz. Sh. <br />Consistence <br />I <br />Al <br />I Boundary <br />I <br />! CS <br />' Scil Acclication Rate <br />I Roots I GPr./Ff I <br />•F i 'S R,2 <br />� 3vF� � � l 6 <br />Soil Application Rate <br />GPD/f? j <br />.`lt#„ <br />I .`ff#z <br />7 <br />46 i <br />I <br />I ,J Boring # U conng q _ <br />I I jZ Pit Ground surface elev. / It. Depth to limitnq factor 7 7 in <br />Horizon <br />Depth <br />in. <br />Dominant Color <br />Munsell <br />'14 <br />Redox Description <br />Cu. Sz. Cont. Color <br />Texture <br />/5 <br />I Structure <br />! Gr. Sz. Sh.. <br />�Z,v, S G K <br />Consistence Boundary <br />f <br />5 <br />Rcets <br />c e, <br />Soil Application Rate <br />GPD/f? j <br />.`lt#„ <br />I .`ff#z <br />7 <br />46 i <br />I <br />• CfA,,...,. <br />u� - Onn <br />i <br />--- -- — --� �� Z 1 J IIiy#L trrtuent R1 =BOD < 30 mgiL and TSS < 30 mg/L <br />CST Name (Please Print) ignature I CST Number <br />Address _ <br />Date Evaluat;cn Conducted Telephe Number <br />-43— /IF7l� 6- on4157 <br />