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N/isconsin 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 <br />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, o3lcel 1.8. y0 �� kQ,Olt ob0 <br />scale or dimensions, north arrow, and location and distance to nearest road. <br />Please print all information. Re iewed by ate <br />Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04(1) m -Y <br />Property Owner Property Location ❑ <br />De, K /0 K v 'PAY Govt. Lot$r '/, S T YO N R v E (or) W <br />Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# <br />PC /36)e 31.5 <br />City State Zip Code Phone Number ❑ Ci <br />1�1/e�il�ti✓ WT 8g 3 �' ❑village ®Town Nearest Road a178� <br />Or,X4 c¢ 1?e b6 /e 17d <br />❑ New Construction Use: ❑ Residential/Numberof bedrooms Code derived design flow rate GPD <br />❑ Replacement ❑ Public or commercial - Describe: <br />Parent material Flood Plan elevation if applicable ft. <br />General comments and recommendations: <br />Privybol.,h <br />Boring # ® Boring 7 pts <br />❑ Pit Ground surface elev. 97-T. Depth to limiting factor in. <br />Horizon <br />Depth <br />In. <br />Dominant Color Redox Description <br />Munsell Qu. Az. Cont. Color <br />Texture Structure Consistence Boundary <br />Gr. Sz. Sh. <br />--11 n NnUauU11 nate <br />Roots GPD/Ft2 <br />*Eff#1 *Eff#2 <br />*Eff#1 *Eff#2 <br />Address <br />, 7-760 ,�,! 3s <br />Dat valuation Conducted <br />�-ao -ir <br />Telephone Number <br />71s=Y�6— L/1.5-7 <br />d <br />S- 30 <br />/.Si1? y <br />SGr <br />�• <br />.7 /6 <br />F -] <br />Boring # <br />❑ Boring <br />❑ Pit Ground surface elev. ft. Depth to limiting factor in. <br />Horizon 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 />vvn n Nucauvll rcaie <br />GPD/Ftz <br />*Eff#1 *Eff#2 <br />Address <br />, 7-760 ,�,! 3s <br />Dat valuation Conducted <br />�-ao -ir <br />Telephone Number <br />71s=Y�6— L/1.5-7 <br />CST Name (Please Print)// <br />-' -- - <br />Signat e / <br />..y. J � IJV 111 /L <br />CST Number <br />Address <br />, 7-760 ,�,! 3s <br />Dat valuation Conducted <br />�-ao -ir <br />Telephone Number <br />71s=Y�6— L/1.5-7 <br />w•1-b.l4-e,r W_T- „5'1{5',7 3 St3U-13330 (R04/15) <br />