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Wisconsin Depararrent of Commerce SOIL EVALUATION REPORT Pap ` of <br /> Division of Safety and Buildings <br /> in accordance with Comm 85,Wit. Adm. Code <br /> Attach complete site plan on paper not less than B 1/2 x 11 inches in size.Plan must C <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. R Date <br /> Personal information you provide may be used for secondary purposes(Privacy Law,a.15.04(1)(m)). rjit 03 <br /> PropOwner Property Location <br /> ;'V C/f 7 Govt.Lot 1/4 S 1/4 S T 1fQ N R//� &f9i=W <br /> Property Owners Mailing rens Lot# Block# Subd.Name or CSM# / <br /> rzo i? 7 /r'iI -�; ,0 /c o - ,670o5,e�1 �Ju6 <br /> City State Zip Code Phone Number ❑city ❑v'dlage P Town Nearest Road <br /> X70 (a)fW-9B 3 G !P? A/ <br /> New Construction User Residential/Number of bedrooms-- Code derived design low rate GPD <br /> ❑Replacement Q Public or omme al Describe: x <br /> Paren:material -sFlood Plain elevation lfapplicable /V l} ft. <br /> General comments <br /> and recommendations: <br /> SE 9d S KS Ae, <br /> Boring# Q Boring <br /> WPit Ground surface elev. 970 ft. Depth to limiting factor��in. FSa—Applicaiion 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 I •Eff#2 <br /> 4� -7 <br /> ,4 c <br /> 7 - — - 411 <br /> F�ilBoring# Boring <br /> Pit Ground surface elev. ft. Depth to limiting factor 1!5'0 in. Soil Application Rate <br /> Horizon Depth Qominant 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 /> •Eftluent#1=BOD >30<220 rrglL and TSS>30<150 mglL •Eftlu #2=BOD.,;S 30 mg&and TSS<30 mg/L <br /> CST Name(Please Prirt) , . Signa CST Number <br /> Septic Systems <br /> Address P.O. BOX 160 Dale Evaluation 96nductad Telephone Nurnber <br /> SHELL LAKE,WI 548711 Q <br /> (ZIr. <br />