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Wisconsin Department of Commerce SOIL EVALUATION REPORT Page-Z—aL.3— <br /> Division of Safety and Buildings <br /> in accordance with Comm 85,Wis. Adm. Code <br /> County <br /> Attach complete site plan on paper not less than 8 112 x 11 inches in size.Plan must <br /> include,but not limited to:vertical and horizontal reference point(BM),direction and parcel I.D. <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. 12. q3.95 -02,-WOO <br /> Please print all information. Reviewed by Date <br /> Personal information you provide may be used for secondary purposes(Privacy Law,a.15.04(1)(m)). <br /> Property Owner Property Location <br /> /)Iez rA- T,a Govt.Lot AlIA/ 1/4 /VW1/4 S 9 T LIQ N R E(or W <br /> Property Owner's Mailing Address Lot# Block# Subd.Name or CSM# <br /> L � /a n e 6 r2 S�-H,n S�n add f o V <br /> City State Zip Code Phone Number ❑City ❑Village IS Town Nearest Road <br /> New Construction Use:® Residential/Number of bedrooms , �_ Code derived design flow rate_ S�`� GPD <br /> ❑Replacement ❑ Public or commercial-Describe: <br /> Parent material-� In G/,4l e,c-, hi-In%L Flood Plain elevation if applicable ft. <br /> General comments l <br /> and recommendations: <br /> 9/ p-o `" « <br /> f Boring# <br /> Q BoringPit Ground surface eiev.9 5!7,ft. Depth to limiting factor�_in. <br /> Soil ication 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 /> 7, 3/3 h i5ri�- S <br /> Boring# ❑ Boring C L <br /> 0 pit Ground surface elev. `7 � oft. Depth to limiting factor.> 7J in. <br /> Soil ication 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 /> *Effluent#1=BOD >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 Prirlt)� ',"� Ignature 3 CST Number <br /> ntxA <br /> 15-2/ <br /> 1,1k, <br /> Adds Cate Evaluation Conducted Telephone Number <br />