Laserfiche WebLink
Wisconsin Department of Safety and Professional Services Page I of 3 <br />Division of Industry Services ORIGINAL <br />SOIL EVALUATION REPORT <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, Parcel I. D. �+ <br />scale or dimensions, north arrow, and location and distance to nearest road. Z N <br />Please print all information. Reviewedy Date � <br />Personal information you provide may be used for seconds purposes Priva Law, s. 15.04 1 (m6 7 -Jo "Ipp <br />Property Owner Property Location ❑ <br />C., cif on C 0 0 ell Govt. Lot Up '/, IVIe %4 S� N RE (or) W <br />Prope Owgei's t�Qaili g Addres Lot # Block # S bd. Name or CSM# �0V LLA <br />C. JC �)dq �' i 7 <br />City State Zip Code Phone Number ❑ ❑ T , <br />city Village 9 � St wn , Ne 1rest R Qad /I fl <br />V�New Construction Use: MResidential /Numberof bedrooms 2, Code derived design flow rate 7jnPD <br />❑ Replacement(' El blic or comm mercial — Describe: <br />Parent material v i j1 c `; T. ) 1 Flood Plan elevation if applicable ft. <br />General comments and recommendations: � � f i <br />Q Boring # Boring 9f 7,,) <br />Pit Ground surface elev. //lift. Depth to limiting factor <br />Horizon <br />Depth Dominant Color Redox Description Texture <br />In. Munsell Qu. Az. Co t. Color <br />Structure Consistence Boundary Roots <br />Gr. Sz. Sh. <br />GPD/Ft2 <br />*Eff#1 *Eff#2 <br />Telephone Number <br />--7-5 <br />ti <br />2 <br />ENFAi i�Ar►7���� <br />Boring # ❑ Boring - it. i <br />�i Pit Ground surface elev.�� Depth to limiting facto�/� <br />CSA N me (Please Print) Signature <br />r <br />rr Dominant Color.. rr - • <br />Munsell • .. <br />A <br />• <br />• - . • - rr <br />Telephone Number <br />ti <br />ENFAi i�Ar►7���� <br />CSA N me (Please Print) Signature <br />r <br />CST Auer <br />A <br />Addfess 1�q _k Date Eva uati Con ted <br />Telephone Number <br />ti <br />Z5-tiU-6JJU (KU4/15) <br />