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Wisconsin Department of Com erce SOI EVALUATION REPORT Page ) of
Division of Safety and Buildings SI.i;rcuii ,uuN V Y
ZONI & m 85,Wis. Adm. Code
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size.Plan must County > 74,7
include,but not limited to:vertical and horizontal reference point(BM),direction and Parcel I.D. 0 0l 1/�,f�/a�v o
percent slope,scale or dimensions,north arrow,and location and distance to nearest road. " Y
Please print all information. t6ie Date
Personal information you provide may be used for secondary purposes(Privacy Law.s.15.04(1)(m)).
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Property Owner Property Location
-/17/, )).5 -y Govt.Lot N4- 1/41ff 114 S 7 T2/ N R /9/Mg
Property Owner's Mailing Addre Lot# BI Subd. or /
i, /92 ° Ax /,- A >dk'Z' > X .. .E
City S Zip Code Phone Number ❑City ❑Village EI Town Nearest Road
-5;mfe- ,4- Ilil T e 5-1 ( ) ir>,E,<1.1 f I S __'s 4
lEJ New Construction Use:g Residential/Number of bedrooms .3- / Code derived design flow rate s"d- .6Q GPD
❑Replacement ❑ Public or commercial-Describe: ___
Parent material, Flood Plain elevation if applicable ft.
General comments . /6:9'77 ' 'of J'W.d t()- s-
and recommendations: sf '°' /
>A /0
ii# ❑ Boring Bc4ing/ - tbl Pit Ground surface elev.X42,0 ft. Depth to limiting factor .5 in. ,
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff;
in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. •Eff#1 •Eff#2
/ (t)- 7 A7 3J ,v� . / ,%>411 ,��, ,,,,.) ,/ . 7 i _
y�4 `,5W�� /� �� s �d " A< IF' _ I 7 _L2
' cz-2Z s- <s /-.re'iza '1,,,, 04, ., I s — 0 ,,-.2
7 44 L7 FJ„.)
Boring#
❑ Boring
pit Ground surface elev. /6:2, 1 ft. Depth to limiting factor 62::2 1 in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consisten Boundary Roots GPD/ff
in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. /J •Eff#1 •Eff#2
I —fis is ?/5/ .A is ";/ mu f>-, ei,) /i,-, , 7 l,c_:2-
j?,sa i ika-/h ,r, k , -; / IYiJ-J 4< it . r 7 I,2
3 -/-i/,s- ��� A* ,rseldp, '�� _s)wiol, rte-. 4S — 0 .,.�
l L -Lig
•Effluent#1 =BOD5>30<220 mg/L and TSS>30<150 mg/L •Effluent#2=BOD5<30 mg/L and TSS<30 mglL
CST Nann(Please Print) pn,ure p a CST Number
15ri6:^ I�r^-e/( � 2 3 i r / V
Address Date Evaluation Conducted Telephone Number
3 Q - /y 2 G. ve S''rh case 4- 11,l /2— l V—63 7/X— Z 4/7c,7Z°J
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Property Owner ce).? )29e/s. ���Parcel ID# Page •-V of 3
Boring# Boring
Pit Ground surface elev. /0/9,S It Depth to limiting factor 7® in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff
in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. •Eff#1 •Eff#2
- MEI
to9iiS h/✓K iJi.1Lf.E
Boring# ❑ Boring
❑ Pit Ground surface elev. ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/IF
in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. •Eff#1 •Eff#2
Boring# ❑ Boring
❑ Pit Ground surface elev. ft Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/fe
in. Munsell Qu.Sz. Cont Color Gr.Sz.Sh. •Etf#1 'Eff#2
•
•Effluent#1=BOD5>30<220 mg&L and TSS>30<150 mg/I_ •Effluent#2=BOO,<30 mg/_and TSS<30 mg&L
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see-8330(R.rrw)
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Address
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..,t1.' Benchmark 1 a, /000 TO NE 4ot-
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