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Wisconsin Department of Commerce SOIL EVALUATION REPORT Pace- _ of��. <br /> Division of Safety and Buildings __ <br /> in accordance with Comm 85,Wis. Adm. Code <br /> Attach complete site plan on paper not less than 8 1/2 x 11 inches in size.Plan must County JA r h� <br /> include,but not limited to:vertical and horizontal reference point(BM),direction and Parcel I.D b/Z G 18 of <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road _ �ffQ 00 <br /> Please print all information. Reviewed by <br /> Personal information you provide may be used for secondary purposes(Privacy Law.s.15.04(11(m)). <br /> Property Owner // i Property Location <br /> v='�✓1 5k 4e ff ee Govt.Lot)4-3 1/4 114 S T 3 / ) <br /> 9 R 6 E or <br /> Property Owner'sMailind Address Lot 1 Bloc::# Subd.Name or CSM# <br /> Y L✓e, l d re1CP t4 , ' P <br /> City State Zip Code Phone Number <br /> ❑City ❑Village ®Town Nearest Road 713 3 <br /> ae S�Io/b c I /✓I�ttiov, �a� Sf©ate R'd1 <br /> ❑ New Construction Use)Z Residential/Number of bedrooms---3 — Code derived design flow rate yS0 GPD <br /> (�Replacement ❑ Public or commercial-Describe: <br /> Parent material G7'AC Ja Iw;)CIL __ Food Plain elevation if applicable -'V'//q <br /> General y <br /> comments <br /> _. and recommendations: 5yj- t" 1,°i/• <br /> , <br /> I <br /> ' ' I Boring T <br /> Boring <br /> L_� ® pit Ground surface elev. 9 ft. Depth to limiting factor 7 in. <br /> Scil Aeelication Rate <br /> Horizon Depth Dominant Color RedoxDescription ! Texture ! Structure Consistence Boundaryl Roots I GPD/ff <br /> in. Munsell Cu.Sz. Cont.Color ! Gr.Sz.Sh. l •E fn1 •E.-#2 <br /> w' 6- q 7,5'z173/at 1' E l S /mS�!< <br /> eY -7 4/ IFS ;z 3 60 <br /> 17- 7 7,5"11Iz y - I / S w t /� <br /> 3�f 7,syi7 e d s''ti2%s C /msblt <br /> I , <br /> I j ! Boring# _® Boring <br /> III `^" III Lf Pit Ground surface elev --�7, ft: Depth to limiting factor 3 b <br /> Soil Application Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/f? <br /> im Munsell Clu.Sz. Cont.Color Gr.Sz._Sh. 'Eff#1 'Eff#2 <br /> 7 4 6 <br /> 51-30 Its � -9/-t ( 1�, <br /> �? 3y 75-IR <br /> { coo o, o I <br /> � I <br /> I <br /> Effluent 91 =BOP >30<220 mg/L and TSS>30<150 mg/L 'Effluent#2 BOD,<30 mg/L and TSS<30 mg/L <br /> CST Name[Please Print) I Signature /� CST Number <br /> i wt,t�s_5 DAti f-ds 73y� C� <br /> Address Date_valuatcn Conducted Telephone Number <br />