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D EE EBWE <br /> D� ta(fc��rce SOIL EVALUATION REPORT Page of <br /> D io f S an t i!d t�" <br /> In ccordance with Comm 85,Wis. Adm, Code County Iful ' <br /> ttach p .paper not les than 81/2 x 11 inches in size.Plan must <br /> nclud%RKbT`Et 1Pb� b"d horizontal reference point(BM),direction and Parcel I.D. <br /> p Yli3TTR3ftw,and location and distance to nearest road. .,(,Y2 <br /> Date <br /> Please print all information. Q <br /> L) . p v wed by [JIAIA14011 <br /> Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). <br /> Property Owner � Property Location <br /> // �/e /� Govt.Lot tV W 1/4 1/4 SZ7 T 'tD N R /5'E(o W <br /> �' f� <br /> perty Owner's Mailing Address Lot#76-1�0 -4 <br /> Sub <br /> Pro d.Name or CSM# <br /> 32 c'' w, /ni <br /> Nearest Road <br /> City,, State Zip Code Phone Number ❑City ❑Village Town <br /> ,lac 'e L ,1 _ ��= _ � (10A >��7 <br /> New Construction Use: Residential(Number of bedrooms <br /> Code derived design flow rate GPD <br /> ❑Replacement ❑ Public or om` Lrcial-Describe: <br /> Parent material <br /> 6laCAI /Jr y+ Flood Plain elevation if applicable ft <br /> General comments Pr <br /> and recommendations: i V`, j&0r;Nq <br /> ® Boring g�.., <br /> Boring# ❑ Pit Ground surface elev. +•-5'ft. Depth to limiting factor in. Soil A lication Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots �E GPD/ffEff#2 <br /> in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. <br /> 2 6-64 7-4* 1 �L r A? I Z <br /> Z �ir OZ. <br /> El Boring# <br /> ❑ Boring <br /> ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF <br /> in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. *Eff#1 -Eff#2 <br /> I <br /> i <br /> I <br /> 'Effluent#1 =BODS>30<220 mg/L and TSS>30<150 mg/L 'Effluent#2=BOD5<30 mg/L and TSS<30 mg/L <br /> CST Name Please Print Signature ��^� C T Number <br /> ( )iCoyS %le. 95/?sy <br /> Address Date Evaluation Conducted Telephone Number <br />