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Wisconsin Department of Safety and Professional Services Page of <br />Division of Industry Services <br />SOIL EVALUATION REPORT <br />In accordance with SPS 385, Wis. Adm. Code County V N� <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. r1$ a0 �� r �� t `!3 Sn 5 Q 3 o i �D� o <br />Please print all information. Revie by Date <br />Personal information you provide may be used for secondary purposes Privacy Law, s. 15.04 1 m . <br />Pr rty Owner _ Property Location <br />o eJ ❑ [� <br />STC No Irk 1 Govt. Lot '% '/4 S T `(J N R / L� E (or) W <br />Property Owner's Mailing Address Lot # Block #=ubd Name or CSM# <br />S HAI` L(J 1I.t �") Y <br />city St to Zip Code Phone Number ❑City ❑Village [Town Ne rest Road <br />L Sal ? �l �.S'� aT�' i� rte ft lshlaU 1k / t? <br />New Construction Use: 2Residential /Number of bedrooms ` Code derived design flow rate 1, D?,PD <br />❑ Replacement ❑ Public or commercial — Describe: <br />Parent material L!} t It a U- �— Tv✓A S H Flood Plan elevation if applicable ft. <br />General comments and recommendations: J M <br />F-11Boring # F-1Boring' /00 <br />Pit Ground surface elev. ft. Depth to limiting factor in. <br />Cnil Cnnlirnfinn Rnfc <br />Horizon <br />Depth Dominant Color <br />In. Munsell <br />Redox Description Texture Structure <br />Qu. Az. Cont. Color Gr. Sz. Sh. <br />Consistence <br />Boundary Roots GPD/Ft2 <br />*Eff#1 * ff#2. <br />.7 <br />�-` 7.sYrt3z <br />s� <br />w.,1 <br />,7 <br />a <br />t4- 3 5- <br />S <br />( <br />W 7 <br />00 ? 5f <br />Boring # ❑ Boring <br />Pit Ground surface elev 660 t. Depth to limiting factor l0O in. <br />Cnii Annlirnfinn Rnfo <br />Horizon Depth Dominant Color <br />In. Munsell <br />Redox Description Texture Structure Consistence <br />Qu. Az. Cont. Color Gr. Sz. Sh. <br />Boundary Roots GPD/Ft2 <br />*Eff#1 *Eff#2 <br />d 7ir1,Y, 3 <br />Date Evaluation Conducted <br />I/- ar- 17 <br />.7 <br />1 <br />d- 3 75- 1 r" <br />S F o�b1 <br />/ ` <br />W 1 r <br />�.�_�,�.7 s 1Vtt 6 <br />1 <br />t <br />��rll�r9lbf ticl�u�fuv/���i:Gri `I.T.�wl�lsuc �Y4l��ilr/-i�6iif�f-TSi:Yi7Gl�1��7[UC�/YI��"..T.rl <br />CST Na (Please Prin <br />Aj �Iacd�-A- <br />Signature <br />CST Number <br />5330 <br />Address <br />9"f <br />Date Evaluation Conducted <br />I/- ar- 17 <br />Telephone Number <br />7(5 q 1 /6q.) <br />bbU-633U (H04/15) <br />