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Wisconsin Department of Commerce SOIL EVALUATION REPORT Page / 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 U(-Nc r <br /> include,but not limited to:vertical and horizontal reference point(BM),direction and Parcel I.D. G 100 <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. -G 0 `4DO <br /> Please print all information. Reviewed Date <br /> Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). �03 <br /> Property Owner Property Location <br /> Totwe 60 e N e- Govt.Lot 1/4 1/4 S �u T 1-/Q N R /S E(or W <br /> Property Owner's Mailing Address Lot# Block# Subd.Name Zx1,6f <br /> l Z d � fh�ve— N /fiL C n� d-Z <br /> City State Zip Code Phone Number ❑City ❑Village Town Nearest Road <br /> P/ n�fh �'!N 55yy6 c763) y7�- Y�197 ,tckso N O- �� G <br /> New Construction Use: Residential/Number of bedrooms 3 Code derived design flow rate 1/3'0 GPD <br /> ❑Replacement / ❑ Public or commercial-Describe: <br /> Parent material 6l`LC��f/ ���T7 Flood Plain elevation if applicable ALL ft. <br /> General comments �y D <br /> and recommendations: GfL ! S� IsANGG 9�j <br /> Y DOTT��-r ?Z. 95.9 g0 5- 92.3 <br /> Boring# ❑ Boring <br /> Z pit Ground surface elev. /�•b ft. Depth to limiting factor S� in. <br /> 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. I 'Eff#1 'Eff#2 <br /> 1 0-% 7,579312 Z5 lmshA Z11n - Z <br /> Z q-5& 7.5Y y/ P5 hvl 65 /F - Z Z <br /> 3 5 7 S�YR / Flf5'Y S n-� Z 6 5 'L/F 7 l Z <br /> FE <br /> Boring# Boring <br /> Pit Ground surface elev. r G ft. Depth to limiting factor ` in. <br /> 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 I 'Eff#2 <br /> 1 - 7 5V '12 2 S lm L Zvi )2 <br /> -6 7,5- /Y 5 0 / 6e7 i 7 1.Z <br /> 6 5-f71 �' ZS/ ILI- 6 S — ) l <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 Na a(Please Print) Sign re // � CST Number <br /> o %ll cr JaG�I S-1 SL( <br /> Address Date Evaluation Conducted Telephone Number <br /> 27 6a 574 ol cWfle (715) <br />