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Wisconsin Department of Commerce SOIL EVALUATION REPORT Pageof <br /> Division of Safety and Buildings <br /> in accordance with Comm 85,Wis. Adm. Code <br /> Attach complete site plan on paper not lass than a 1/2 x 11 inches in size.Plan must Countya,,,je- <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 forsecondary purposes(Privacy Law,s.15.04(1)(m)). <br /> Property Owner Property Location <br /> C C Govt.Lot 1/4 1/4 S <br /> Q to T39' N R16 E(o W <br /> Prope Owner's Mailing Address 1 Lot# Block# Subd. Nam&or-68M# <br /> Ch till� /\ V ^�� /1') �L / / <br /> City State Zip Code Phone Number ❑City ❑Village Town Nearest Road <br /> ❑ New Construction Use:(Residential/Number of bedrooms Code derived design flow rate_��C-)_ _GPD <br /> §A.Beplacement /1 Public or commercial-Describe: <br /> Parent material (Y�C if} d/`i�f' Flood Plain elevation if applicable <br /> General comments L [ <br /> and recommendations: 7L/77 A- 7L /? <br /> "PJ'r C G <br /> FPBoring# ❑ Boringfia S <br /> Pit Ground surface elev._775___ft. Depth to limiting factor__ in. <br /> Soil Application Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/If <br /> in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 'Eff#2 <br /> l _S 7, fi2 S G s <br /> Ara 7 Pr <br /> Yov <br /> Boring# ❑ Boring q <br /> Pit Ground surface elev. / 7, ft. Depth to limiting factor 4 <br /> /1 C) in. <br /> Soil Application Rate <br /> Horizon I 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 /> cs /,2 <br /> CJ <br /> Effluent#1 =BOD >30<220 ng/L and TSS>30<150 mg/L 'Effluent#2=BOD <30 mg/L and TSS<30 mglL <br /> CST Name(Please 'M) Signature CST Numbger <br /> Address Date Evaluation Conducted Telephone Number <br /> /3 ox�/ Y .Sr/`'c.,v L✓�5��7�- �/�/7-a� �Y`�-��8'� <br />