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Wiauunsin Department of Safety and Professional Services nn _ Path of <br /> Division of Industry Services C.—D l --z 5-7 <br /> SOIL EVALUATION REPORT <br /> in ac cordancewi h SAS 385,Wis. Adm. Code CounlY <br /> Attach complete site plan on paper not less than 8 in 11 inches In size.Plan must include, putt./ � <br /> but not limited to:vertical and horizontal reference point(BM),direction and percent slope, Parcel I.D. <br /> scale or dimensions,north arrow,and location and distance to nearest road <br /> Please print all information. byDate <br /> Personal Information you provide may be used for secondary purposes(Privacy 1.ew,s.15d)4(1)(rn)i. ; - . g /�a <br /> Property Owner Property Location c <br /> Et <br /> ,Ortad Nt/i7nN Iovt Lot Z T! Y 8 Z e T 3g N R (7 E (or) W <br /> Property Owners Me ng Addressfn41L Su <br /> Lot# Block# bd.Name or CSM# <br /> MICA{ 4 l'YIiJ (5ante p Code Phone Number p city ❑age 2 Town Road <br /> 1 ( ( ) I I ,ore/, ! rt,yr [k��/ <br /> 0 New Construction thew EN Residenllel/Numberof hadmtims /4 Code derived design flow rats b�QPD <br /> 3 Replacement / ❑Publi or�}[n al—Describe: <br /> Parent material G`¢Gi a1 �f 7 irme Flood Plan elevation if applicable iik74 R. <br /> General comments and recommendations <br /> Boring# Q Boring c <br /> ®Pit Ground surface elev.9+ ft. Depth to limiting lector ',� in. <br /> Now Qeptir Dominant Color 12edax DescriptionSoil Application Rate <br /> tn. Mures Qu.Az Cont l r Tim Structure Consistence Boundary Reefs c3PD/ <br /> Gr.Sz Sh. <br /> 1 0- 75 v27lz �bk TMTM <br /> Z • 7- “. /� y�'IL G� Zh, _ 7 l 6 <br /> 7 5-YWOJI — S Grp+ // L 6 /F , 7 1-4 <br /> 17 `5"-77 7,3-0/y F/F 5Y1e5/8 `y 1/11 <br /> 647 . 7 I.6 <br /> Z- oaring# .0 Boring � <br /> Mt Ground surface elev. ?7'tt <br /> Depth to limiting factor 7`l In. <br /> Horizon Depth Dominant Color Rodox Description Texture Soil A•r Mallon Rate <br /> tn. Munselt Qu.Az.Cont.Color B.ru� Consistence Boundary Root C3PD/Pts <br /> Gr.Sz.Sh. <br /> e-7 1 Y //z 'sot 'E> <br /> '- , 7 y/l 9 irks; y �5 / /,G <br /> rgL tS, . 7 I. <br /> • --cent#i=13oD >so s 220 ;. <br /> and TSS>30 s 1:• .. :Efituent#2=SOD '30 s 220 <br /> CST Name(P�;-:=Pri �, and . > >s� � . <br /> y <br /> it0/ �' t nett"'a / '� COT Number <br /> YTt'N i+/�/ lj o '�, i Date Evaluation Conducted Telephone Number <br /> SOO-8330(R04/15) <br />