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Wisconsin Department of Safety and Professional Services <br />Division of Industry Services <br />SOIL EVALUATION REPORT F -I -h f7;k, <br />In accordance with SPS 385, Wis. Adm. Code Counifr f <br />Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, ` �-, '/ <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. 0 i L( p <br />Please print all information. Reviewed b I /J <br />Page of <br />a`lSoS 00,5- o.230 <br />Date <br />Personal information you provide <br />may be used for secondary purposes(Priv ac Law, s. 15.04 1 m . <br />V, <br />Ground surface elev. ft. <br />ll—.76-17 <br />P o Owner <br />r <br />At" <br />Property Location <br />Govt. Lot '/< <br />%< S � �"I <br />j F -15Z <br />LIQ I <br />t� <br />C A � � J� <br />7,,r / <br />T <br />N R / E (or) W <br />Property Owner's Mailing <br />Address <br />C <br />Lot # <br />Block # <br />Subd. Name or CSM# V iD <br />? � <br />w� <br />1 <br />G <br />C' yState <br />Zip Code Phone Number <br />El city [:1Village Town <br />Nqa est Road <br />d fj <br />r� t <br />❑New Construction Use: Residential/ Number ofbedrooms Code derived design flow rate <br />❑ Replacement ❑ Public or commercial — Describe: f , <br />Parent material C,4 L i L �,T ✓ A S tT Flood Plan elevation if applicable ft. <br />General comments and recommendations: <br />aBoring # <br />❑ Boring <br />(( Pit <br />V, <br />Ground surface elev. ft. <br />Depth to limiting factor (� in. <br />Consistence Boundary Roots <br />GPD/Ftz <br />*Eff#1 *Eff#2 <br />*Eff#1 <br />Snil Annliratinn Rata <br />Horizon <br />Boring # <br />Depth <br />In. <br />Dominant Color <br />Munsell <br />Redox Description Texture Structure <br />Qu. Az. Cont. Color Gr. Sz. Sh. <br />Consistence Boundary Roots <br />GPD/Ftz <br />*Eff#1 *Eff#2 <br />*Eff#1 <br />*Eff#2 <br />S. <br />�� �,r <br />7,,r / <br />'n't s � h <br />Li <br />3-0 2(l/i <br />Lo <br />S !� Lrl . <br />5. <br />w� <br />HI <br />G <br />k Ll <br />El Boring Cl �� < .i <br />b <br />171 pit Ground surface elev. � ft. Depth to limiting factor in. <br />Snil Annliratinn Rata <br />Horizon <br />Depth Dominant Color <br />In. Munsell <br />Redox Description Texture <br />Qu. Az. Cont. Color <br />Structure Consistence <br />Gr. Sz. Sh. <br />Boundary Roots <br />GPD/Ft2 <br />*Eff#1 *Eff#2 <br />Date Evaluation Conducted <br />�- �YrZ3 <br />S. <br />�� �,r <br />C�-' <br />,L I• <br />3-0 2(l/i <br />4 <br />I.�!���!►r�,�'r <br />HI <br />G <br />1-ttluent 7F1 =H()11 > 311 S "l Jn mn/1 ann 1 SS > 3n 5 1 Ml mn/1 ' F-ttluant #7 = WN ) > .in 5 7"ln mn/1 ann I SS > an 5 1h11 mn/1 <br />CST Na (Please nt) <br />Signature <br />CST Number <br />=� v� <br />Address _ <br />Date Evaluation Conducted <br />Telephone Number <br />'9�J ,,bb1J-W3U (KU4/1 b) <br />5N SJ l <br />