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Wisconsin Department of Safety and Professional Services IGINAL p--1-- °f 3 <br />Division of Industry Services <br />SOIL EVALUATION REPORT q$T — J-) — 1 � 3' <br />In accordance with SPS 385, Wis. Adm. Code County <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, V �. P1arcel I.D..j <br />scale or dimensions, north arrow, and location and distance to nearest road. j -7.1-650-r, 60! <br />Please print all information. Revi by 4e Date C% <br />Personal information you provide may be used for secondary purposes Priva Law, s. 15.04 1 m 1/9-'/-/7 <br />Property Owner Property Location ❑ <br />►° Govt. Lot Y. 'K/'/. Se(, T 7A -Ln/ N R E (or) W <br />Property Owner s Mailing Address Lot # Block # Subde or CSM# <br />10 <br />Ci State Zip Code Phone Number ❑ City ❑ Village JK1 Town Nearest Ro d <br />GF <br />[ New Construction use: Residential/ Number of bedrooms "; Code derived design flow rate GPD <br />❑ Replacement`` ❑ Public or commercial - Describe: <br />Parent material h �/w �� �'� l l Flood Plan elevation if applicabl4vA ft. <br />General comments and recommendations: SW� `� 4�t'D` <br />Boring # El Boring <br />111 <br />Pit <br />Ground surface elev. ? [1'cl� Depth to limiting factor��n. <br />Horizon Depth <br />In. <br />Dominant Color Redox Description <br />Munsell Qu. Az. Cont. Color <br />Texture <br />Structure <br />Gr. Sz. Sh. <br />Consistence Boundary Roots <br />GPD/Ft' <br />*Etf#1 *Eff#2 <br />1 r Ll <br />5 s' <br />L <br />1 <br />, <br />11 <br />% <br />� It <br />�^ r <br />1 <br />Boring # <br />❑ Boring �/ (� <br />Ig Pd Ground surface elev. 9 C , 4• <br />Depth to limiting factor >6V/in. <br />Horizon <br />Depth Dominant Color <br />In. Munsell <br />Redox Description <br />Qu. Az. Cont. Color <br />Texture <br />Structure <br />Gr. Sz. Sh./C <br />Roots <br />GPD/Ft2 <br />*Eff#1 *Eff#2 <br />Telephone Number <br />^ <br />�`1"2L <br />1 <br />r <br />LConsistenceBoundary <br />G <br />ZF <br />e <br />- - — _ <br />CST Name (Please <br />Y <br />-' -- -- — -- — <br />Signature el <br />— 01lu 1 QJ - JV � IJV 111 /L <br />CS Nu ber <br />/Print) <br />Ado ssZ <br />Date Evaluation Conducted <br />Telephone Number <br />^ <br />1 <br />r <br />Jt3U-t33:SU (KU4/15) <br />0 �� <br />