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Wisconsin Department of Commerce SOIL EVALUATION REPORT <br />Division of Safety and Buildings <br />in accordance with C 85 W' A <br />ORIGINAL <br />omm , ts. dm. Code <br />Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must Counry i <br />include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel 1.0 <br />percent slope, scale or dimensions, north arrow, and location and distance to nearest road. 3� .• .S O1- 03 800 i <br />. .��..., <br />r-.... .... •.n - u•aa ua,•, r. <br />Depth <br />in. <br />Dominant Color <br />Munsell <br />..aimPersonal <br />information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1}(m)). <br />La <br />Structure Gr. SzSh <br />. . <br />�— <br />Property Owner <br />Property Location <br />•Eff#i <br />•Erf#2 ! <br />�/ <br />N�rr �� 'eHow 5k' <br />Govt. Lot 1/4 1/4 S <br />8 T y/ N <br />i <br />R �S" E (or)�� <br />Property Owner's Mailing Addfess <br />Po Bo >< 3b,� <br />tot # oloBlock# Subd. Name or CSM# <br />City State Zip Cade Phone Number <br />❑City ❑ Village ® Town <br />Nearest Road <br />/)w� r w1- .8'30 ) <br />av-s <br />71-51wZ �'l <br />rtj <br />s <br />a�s6k <br />I <br />I <br />s <br />❑ New Construction Use: [I Residential / Number of bedrooms _ _�_, <br />Code derived design flow rate <br />7Oe'�— <br />GPD 1 <br />(f Replacement ❑ Public or mmercial - Describe: <br />Parent material tell,�a G/� -f <br />l �,� ; <br />-- <br />Flood Pain elevation if applicab,e <br />f <br />General comments S�S le /'e <br />and recommendations: l <br />i <br />j F-1Boring'Boring <br />i <br />—J <br /># <br />n Pit Ground surface elev 9 -7r O k <br />ne..rti r,. �;.,.:.,..., s.._.__ � 71 <br />Horizon <br />Depth <br />in. <br />Dominant Color <br />Munsell <br />Redox Description <br />Qu. Sz. Cont. Color <br />I Texture <br />I <br />Structure Gr. SzSh <br />. . <br />Consistence Boundary <br />I Roots <br />Soil A oollcatio�Ra e <br />GPC/fF <br />•Eff#i <br />•Erf#2 ! <br />o -ao <br />-7,syr7 <br />av-s <br />71-51wZ �'l <br />-- <br />s <br />a�s6k <br />I <br />I <br />s <br />I J► <br />-86 <br />-7. s?s/ <br />i <br />f <br />I <br />I <br />a Boring # U Boring <br />pit Ground surface elev. '7,f. U (t, Depth to limitine factor i 9 t in <br />Horizon <br />Depth <br />in. <br />Dominant Color <br />Munsell <br />Redox Description <br />Qu. Sz. Cont. Color <br />Texture <br />Structure <br />Gr. Sz. Sh. <br />Consistence <br />Boundary <br />Roots <br />Soil Application Rate <br />GPD/ff <br />'Eff#1 -Eff#2 <br />av-s <br />71-51wZ �'l <br />-- <br />s <br />a�s6k <br />, <br />s <br />I J► <br />-86 <br />-7. s?s/ <br />• CfA...,..a <br />N.1 � O/�f1 � 7n <br />- - -- -- - —_ - • •• - _ ...W� r-muent Re = uuu < 30 mg/L and TSS < 30 mg/L <br />CST t�tamw (Please Print) Signature CST Number <br />Address d 7'� �� O <br />Date Evaluation Conducted Telephone Number <br />2s�-ldo �� W , w�. �� I r- IK 7rs- 9�6- 467 <br />