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WmicorsinDtlpartrnantofCommem SOIL EVALUATION REPORT age ar 3 <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 812 x 11 inches In size.Plan must Courtly / <br /> include,but not limited to:vertical and hodzontal reference poled(BM),direction and Pat cel I.D. <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. p O -2 I I 0 -a) ^GO c6 <br /> Please print all Information. Date <br /> Persons'inlommeon You provide msY ee oaed for aboard"Purposes(Privacy Law.s.15,00(1)(m)). <br /> Property Owner Properly Location w r\I+1 'Y <br /> /'a-L./ SFC 1. ( t CL 4+ GovL Lot 1/4 1/4 S/a T 3(S N R /4 E❑(o® <br /> Property Owner's Malting Addressf Lot# Block# S Name or CSM# <br /> a2 o S0 W. S ki I reGh,F LN <br /> Cit' Stale ZIP Code Phone Number ❑Village ElTown Nearest Road <br /> SOct1 k'L ke I tx I I cwS- )46 X870 sk re&* L-V' <br /> New Construction Use Residential/Number of bedrooms Z Code derived design flow rate ?Oy r .GPD <br /> ®Replacemerd Public or commercial-Describe: <br /> Parent material 0-- 1,C r C 7 I Flood Plain elevation if applicable R <br /> mm <br /> General coents <br /> and recommendations: G r c vc I c[i-^o� "J i- k a t L 2 oiJ .Z <br /> L<ss rtil�jo <br /> FI Boring# n❑ Boring <br /> FaPit Ground surface elev. / D R. Depth to limiting factor 2 in. <br /> Sod ADDlication Rate <br /> Horizon Depth Dominant Coloi Redox Description Texture Structure Consistence Boundary Roots GPD#f <br /> in. Munsell Clu.Sz Cont.Color Gr.Sz Sh. 'Eff#1 •EH#2 <br /> r�2 /S 1-{ S)jl( V6,W <br /> ? r 4 I S l-F S6�( ✓ CU — <br /> a Boring# ❑ Boring <br /> it Ground surface elev. q R. <br /> Depth to limiting factor in, soil Application Rate <br /> Horizo Depth Dominant Coo Redox Description Texture Struc(ure Consistence Boundary Roots GPD/IF <br /> in. Munsell Qu.Sz ConL Color Gr.Sz <br /> Sz Sh. 'Efl#1 •Eff#2 <br /> Effluent#1 =BOD >30<220 mg/Land TSS>30< Effluent#2'=SOD,<30.0,&and TSS<30 mWL <br /> CST Name(Please Print) CST Number <br /> Address ne 4223779 <br /> Data Evaluation Conducted Telephone Number <br /> PO Box 161; Gordon, WI 54838 1, - 9/_ p LI 715-376-2278 <br />