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Wisconsin Department of Commerce SOIL EVALUATION REPORT <br /> Division of Safety and Buildings Page ) —of <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 <br /> include,but not limited to:vertical and horizontal reference point(BM),direction andP / <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. arcel I.D.ID0- O 900 <br /> Please print all information. Reviewed by Date <br /> Personal infonnalion you provide maybe used for secondary purposes(Privacy Law,s.15.04(1)(m)). <br /> Property Owner Property Location <br /> Atfm Govt.Lot 1/4 1/4 S T N R & E(or <br /> Props Owner's Mailing A ress Lot# Block# Subd. Name or CSM# <br /> 1.6 So001 AV <br /> , <br /> Cl a Code Phone Number <br /> I ❑City ❑Village Town N crest Road <br /> �1RC�tZoµN�S <br /> ❑ New Construction Use Residential/Number of bedrooms_ Code derived design clow rate GPD <br /> Replacement ❑ Public or commercial-Describe: <br /> _� <br /> Parent material WA p/1j Flood Plain elevation if applicableGeneral comments — ```i -----ft <br /> and recommendations: <br /> Sys_ �i. 99 78 <br /> Boring# OBoting S <br /> ❑ Pit Ground surface elev.�_ft, Depth to limiting factor / _in, <br /> Soil Application 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 Eff#2 <br /> Z /s' tWll <br /> /S-V Gxd s 8 s <br /> 2 Boring# ❑ Boring Ql <br /> Pit Ground surface elev, !8•S tt. Depth to limiting factor <br /> Soil Application Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ti <br /> in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. •Eff#1 'Eff#2 <br /> 0-T �u3 s M1 S 2v- q <br /> S <br /> 3 12-29 -7-54 R 4 4 s s Myr <br /> 4 .S 4 L Czd y 3 Myr ti 1 M .$ <br /> Effluent#1 =BOD >30<220 mg/L and TSS>30:a 150 mg/L Effluent#2=BOD <30 mg/L and TSS<30 mg/L <br /> CST Na (Please Print) Signature CST Number <br /> Address <br /> ZZSSSI <br /> Date Evaluation Conducted Telephone Number <br /> �776o 3S WI. S4 I� ;- o-GZ 71-'5j 6-4+S7 <br />