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�l <br /> Ws.Dept.of Safety add Professional Services SOIL EVALUATION REPORT Page—of <br /> Division of Safety and Buildings <br /> in accordance r41h SPS 3&S,NSs. Adm. Code <br /> Attach complete&uso plan on paper not kris than 8 er x 11 inches in sae.Pion must <br /> C---Y urw��r <br /> indudo,but not .I.o to vertical add horizontal reference pont d!distance <br /> antedirection and! p�1,p. <br /> percent slova.scale aaimemions,nosh snow,and location eM distance to nearest roan. UT'DSbrY/-/S-/S"S /S"Oy3�o Gy0 <br /> Please print all in iorrnation. Reviexea by Data <br /> perianal intemuuon rro lxpvue mar ceases r«neconawy purposes ll'rvacy iew.z.lsafl)(ron. G4A14 <br /> property Dvmer `` property Lavation <br /> pOry Q/JZ God.td 1/4 1/4 Sl T �// N R E(01)� <br /> Property Owner's Mailing Addr/$�ss/�J/-t�+ Ln# Block# $Ilbd.Names CSMA <br /> ,-4j 16, `n�Ql 1713A55 LADE FLK <br /> Qty,,//� State Zra Cotle Phare Number ❑CM []Village ®Town Nearest Road (� 7 <br /> //7M�1 (7/5 )H5�AH9g LVn <br /> WNew Construction Use:gNResidential/Numherofbedrooms Z Code derhadl desgn Hoy,dae 3CO GPD <br /> [-I Replacement ❑ Publicorcann ndal-Describe'. <br /> Parent matenal h14 Cr</� f/fr/-'t <br /> Flood Plan elevation H appirable ft. <br /> General comments <br /> and moommons: �Y�J <br /> SAN-/v-Ya <br /> crr-�y-3/ <br /> ❑ Boring <br /> Boring#IT `F70® pit Ground surface elev.�fl. Depth to limning factor 1 in. <br /> Soil Application Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure nsistence launder, Roots GPOM r <br /> in. Munsell Oa Sz. Cont Color Dr.Sz Sh. R#1 fl#2 <br /> 0-1r 75 2 — / /a L e S z/ <br /> Z 4-117- H/ 5 Olr /a L 5 F <br /> v �R iHL 6t - 7 /•6 <br /> Baring# I� Boring <br /> pit Grouts surface slay. 7b. 7 fl. Depth to tinting factor 7 l in. <br /> Sod liplion Rale <br /> Horizon Depth Dominant Color Red.Desorption Texture Svucture lodsialence tound., I Roots GPDA r <br /> in.I '..Mussefl - Ou.Sr. Cont.Color Gr.Sz.Sh. R#1 '$ff#2 <br /> 71,-971Z 1 r / L .7_ <br /> z -p • 75reyi� . 5 Cl", 1V1 G7 r- <br /> 'Effluent#1 =800, ,>30<220nng+&aMTSS>W0 1wmg& ,-Effhr l2=BOD <Mnryn-.rd TSS-<W-W1- <br /> csr Nam(Ploase print) ) /o�/V <br /> Address �• / Date Evaluation Conducted Telephone Number <br /> 2 77,-?e )4/71;,0/,[ 0 Gv?lr/(r L/ 5/�99� S/� /`/ 66-d"a <br /> SB68330(RI 1/11) <br />