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Wisconsin Department of Commerce SOIL EVALUATION REPORT Page I of 7 <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 81/2 x 11 incites in sae.Plan must <br /> CountyyY/7 <br /> include,but not limited to:vertical and horizontal reference point(BM),direction and paw I.D. e -O f -A-C/O-/ <br /> percent slope,scale or dimensions,north snow,and location and distance to nearest road. p- O A.(O op <br /> Please print all intonnadon. Reviewed by Date <br /> Personal information you provide may oe used for secondary purposes(Privacy Lew,S.15.04(1)(m)). <br /> Property Owner ppm,Location <br /> Adk/ s+& nir 5ovt-Eor 1/4 1/4 S /-'? T 4/0 NN R /-4E(or)OP <br /> Property Owner's Mailing Address Lot# Block# Subd.Name art" <br /> e.to xef/y Or. lA A A T- UT � <br /> City State Zip Code Phone Number ❑city ❑Village JR]Town Nearest Road A <br /> Gsl�le„ VO'/le 1//1,1! S.t4d7 I (6/d ) tv j PS3 1),.G/cs0,1 1 //a/04-MOO" Cif <br /> ❑ New Construction Use:® Residential/Number of bedrooms 3 Code derived design flow rate 9Sy GPD <br /> ®Replacement ❑ Public or commercial-Describe: <br /> Parent material �i C r a / &. A, FloodPlainelevation if applicable N//0 ft. <br /> General comments •Syf <br /> •e/u!d• 4/•,f0 L/4-693• / <br /> and recommendations: • <br /> app( &5 939C - GrayCelhl_/leHla G7 . I <br /> F 71Boring# ❑ Boring <br /> © pit Ground surface elev. �S ft. Depth to limiting factor > 7P <br /> in. <br /> Soil Application Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF <br /> in. I Munsea Ou.Sz. Cont Color Gr.Sz.Sh. •Efl#1 •Ef#f2 <br /> 0 - 3 7SYR3/ — /S Jn,sb/c ,,, / (i S G s 7 / 6 <br /> 'iM sb/c I 45 s., -7 /. G <br /> ? b-H4/ 7Sf/7 l — 3 wSG 1 LS ��0 7 /• 6 <br /> S <br /> Aly <br /> - 60 <br /> Boring# ❑ Boring `JN. <br /> © pit Ground surface elev. ft. Depth to limiting factor > 7-� in. Soil Application Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDN <br /> in. Munsell Ou.Sz. Cont.Color Gr.Sz.Sh. •Eff#1 I •Eff#2 <br /> J o-? 7.sy/z3/ Jr /., sb/c ,. f Gs cs . 7 J, <br /> 4..f,6 le < l 6;�S s." . 7 <br /> 3A.1•X-f --CWZ /S al s 6/e , l 6 S of 0-1 . 7 /, 6 <br /> 4 -1-0--7} '.> YR siq — s o s G �.. 1 — 1- 6 <br /> Effluent#1 =BOD >30<220 nVL and TSS>30<150 mg1L •Effluent#2=BOD,:5 30 mg/L and TSS<30 ng1L <br /> CST Name(Please Print) Si alure <br /> CST Number <br /> Address Date Evaluation Conducted Telephone Number <br /> 7/r- 944�- 4/s7 <br />