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Wisconsin Department of Commerce led <br /> Division ofSafety and Buildin s SOIL EVALUATION REPORT �� <br /> elim,kit ar <br /> • <br /> >> <br /> 4 <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 jJ N n <br /> include,but not limited to:vertical and horizontal reference point(BM),direction and J <br /> percent slope,scale or dimensions,north arrow.and location and distance to nearest road Parcel p7_4,10-1-y0`�fi'07 S -.Sse <br /> Please print all information. c 304,49we Eby <br /> Personal information youbesecondary purposes jPnvacy Law.s 15.04(1)(m))• /t L�� <br /> Property Owner providemay used for / 1 I i�f q <br /> Property Location <br /> 66.•--y 8)ornbrel Govt.Lot .� <br /> !Property Own= ;Mailing Address <br /> 1/4 1/4 S 7 T e/O N R /i, E(or)�J� <br /> g8‘s- y-tr�_1 -?3 ' 6 u.-t--(07‘.5 /Slack# Subd. Name or CSM# <br /> Clry !� State Zip Code Phone Numoer3 <br /> -e.;.5 � 40- <br /> 4 y 1.3 ( 0 City ❑Village Town Nearest Road l8d6S <br /> ❑ New Construction Use:® Residential/Number of bedrooms of <br /> Code derived design flow r;te ,7a0 <br /> ❑Replacement 0 Public or commercial-Describe: ------ ----GPD <br /> Parent material Giac i -- ___ <br /> General comments /�r�� / F°°d Plain elevation if applicable N�/� <br /> and recommendations: eXr3,f. .SYS• G/c✓ 96. 3 ~` <br /> IBorinq# Z Boring <br /> ❑ pit Ground surface elev. 9 5. a ft. Depthlimiting 71 to factor in. <br /> Horizon I Depth Dominant Color Redox Description Texture Structure Consistence BoundaryRoots 1 Soil <br /> Accli <br /> GP <br /> PDtff n Rate <br /> in. Munsell Qu.Sz. Cont.Color <br /> Gr.Sz.Sh. <br /> .s I I I I .7 I �6 <br /> .. adv 7sylz ''/e I — l is 1 <br /> do-SH 7S°f�fG I 1j I I 7 /,C <br /> Li :3y 7y 7sYiZ 7f I s I i . 7 I /c <br /> I I <br /> 1 <br /> I i I i <br /> I <br /> I Boring# <br /> D. Boring I I <br /> LJ Pit Ground surface elev. ft. Depth to limiting factor -_in. <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary t Roots Sod A GpPD/tf n Rate <br /> in. Munsell Qu.Sz. Cont.ColorI <br /> Gr.Sz.Sh. 'Eff#1 I 'Eff#2 <br /> -- I I <br /> I <br /> I I <br /> I !i•- I <br /> (......„...„.„..,----"mili , <br /> •Effluent#1 =80D5>30<220 mg/L and TSS>30< 150 m <br /> CST Name (Please Print) VL 'Effluent#2=BODS<30 mg/l and TSS<30 mg/L <br /> Signature <br /> J AI.%e.-.S ,.S .,?a h til.1 S t l CST Number <br /> Address "A^--- J a(7J 1ni/ Date Evaluation Conducted Telephone—Number <br /> 27760 ,yr7_ 4 t 37 2 , Wl• S'�93 ao-6-,�3 <br /> --—3 76- - +57 <br />