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Q� IGINAL <br /> Wisconsin Department of Commerce SOIL EVALUATION REP Page 1 of3 <br /> Division of Safety and Buildings <br /> in accordance with Comm 85,Ws. Adm. Code <br /> Attach complete site plan on paper not less than 8 1/2 x 11 inches in size.Plan must County t3UR1jETT- <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. <br /> Please print all information. Reviewed by Date <br /> Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). <br /> Property Owner Property Location <br /> DAV I b FIEEfZ Govt.Lot 2i3 -U* M S ,?4 T A10 N R 1!5 *(or)W <br /> Property Owner's Mailing Address Lot# Block# Sebtl.Naraa-0r CSM# <br /> E 4L370 y(�2hae GZv .2 Vol S As 'Z1 z15 <br /> City State Zip Code Phone Number ❑City ❑Village grown of Nearest Road <br /> MENOMwlr-- I U11 I 5Y-751 ( 7/S) 32 9976 Rjr-K16 <br /> Er New Construction Use: Residential/Number of bedrooms .3 Code derived design flow rate 450 GPD <br /> ❑Replacement ❑ Public or commercial-Describe: <br /> Parent material 64iCIAL DRIFT Flood Plain elevation if applicable <br /> General comments <br /> and recommendations: YSr;xm &LEvAnon): 96,4 6o 97. r <br /> Boring# Boring} <br /> [�Pit Ground surface elev. /M 33 ft. Depth to limiting factor 7 8 in. <br /> Soil Application Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' <br /> in. Munsell Cu.Sz. Cont.Color Gr.Sz.Sh. •Eff#1 •Eff#2 <br /> A o-5 7.5 ✓ 3/ -�' �l.S F b mo k CS 3F .7 /.2 <br /> 13 5-R0 S// -rr C my A, 5 2c2rn . /. Z <br /> BG Ro-A61 7. /'k / -r�- S wt <br /> w/ J&W 01N1. 7.5 Ile V16 a LS 055 Fr cis <br /> a- S 4 7S A 5/ a 5 a69 MV f✓ <br /> A'2rt A:. title SfiwE 0n , <br /> 7 Boring# r1J Boring } <br /> 6a Pit Ground surface elev. 99.(o( ft. Depth to limiting factor in. <br /> - Soil Application Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' <br /> in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. •Eff#1 'Eff#2 <br /> A o -4 .5 Yx 3/2 b GS 1 F56 mVFr CS 3F .7 1. 2 <br /> 75 YA 61 -10I c sbK m JFr 35 24.3" <br /> B G 24" 5059 MI - / 7 <br /> 4 14011114 75 A /lo a 059 ntvr* C-5 - •7 z Z <br /> G 75A S/ Ir 05 . 7 <br /> Effluent#1 =BOD,>30<220 mg/L and TSS>30<150 mg/L 'Effluent S=BOD,<30 mg/L and TSS<30 mg/L <br /> CST ame(Please Print) SignatureCST Number <br /> R 1 G r�o-�l RO -;v/ s/ A-f6 <br /> Address ate Evaluation Wducted Telephone Number <br /> X8830 1301gN 5k d AKE )POA0, LV[-&T6e 01 5y2g3 .506-r Z: .'o 745 ,?59 ,3W7 <br />