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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 /> County complete site plan on paper not less than 81/2 x 11 inches in size.Plan must g(gAiell— <br /> Attach <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. 07 pl _z_90-5= r / -1214- G00 <br /> Please print all information. evie d by Da / <br /> ii <br /> Personal information you provide may be used for secondary purposes(Privacy Law.s.15.04(1)(m)). % 1 4 f/f02C <br /> 1 Property Owner Property Location // <br /> 76,F 44/ E Govt.Lot 1/4 1/4 S/3 T 4/0 N R 5—E(oro <br /> Property Owner's Mailing Address Lot# Block# Subs_Name or CS /� <br /> Z lc 61/ek <br /> 4 God 8,1. Per 4 e <br /> Sta e Zip Code Phone Number ❑City ❑Village ['Town Nearest Road <br /> ¢Ad <br /> C?/ <br /> I N I55705r 1 65/ )138--e7 j "J'Qck ol..i 1 Ireov,/cA led <br /> ❑ New Construction Use:{l Residential 1 Number of bedrooms Z Code derived design flow rate 300 GPD <br /> 41 Replacement /// ❑ Public co Gal-Describe: <br /> Parent material brt4C/A/ /r/)s Flood Plain elevation if applicable /Vf' ft <br /> General comments <br /> and recommendations: <br /> I 0 Boring _ <br /> Boring# .V <br /> 4 pit Ground surface elev. ?‘.5ft. Depth to limiting factor 74 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 'Eff#2 <br /> 1 o-g 15-y&z. /S /n64k n 65 in . 1 /.2 <br /> 2- 6_91 Z4►//YIy 4 - y ,91 0 /r1 .7 1 ? <br /> 5 <br /> i I <br /> Z_ Boring# Boring �/ Q�f <br /> 1.4 Pit Ground surfaceelev. / ft. Depth to limiting factor (34 in. <br /> Soil Application Rate <br /> Horizon Depth Dominant Color Redox Description Texture 'Structure Consistence Boundary Roots GPD/T <br /> in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. *Eff#1 "Eff#2 <br /> I e-7 7 /Z /r Y I S Ik. "71.- 217 . 7 12 <br /> 5-56, 7r,y/g 5% /1 C' /i .7 12 <br /> -Fz is ' oy 65 - , 7 1 2 <br /> 1 I <br /> *Effluent#1 =BODS>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) Signature/v �Z CKO+ // J� 57?6* <br /> Address Date Evaluation <br /> Conducted Telephone Number <br /> 01/fav �N 14 61 weito k vs flbq, 7-1-2o 7A5=X66-o2o z <br />