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Wisconsin Department of Safety and Professional Services ORIGINALO.1_4�1_b,Page ofDivision of Indust Services SOIL EVALUATION REPORT <br />In accordance with SPS 385, Wis. Adm. Code Coeanty t� � <br />Attach complete site plan on paper not less than 8 V2 x 11 inches in size. Plan must include, <br />but not limited to: vertical and; horizontal, reference point(BAA),direction and pefcerrtslope, P cell.D. <br />scale or dimensions, north arrow, and location and distance to nearest road, t— 0 $ 00 <br />Ptease print all information. Reviewed Date e{ <br />Personal information you provide may be used for secondarypurposes Privac Law, s. 15.04 1 mLqd2 A-1 <br />Prop e Owner Property Location I l El 14 <br />(7 A1b n/ Govt. Lot E '% '/. S ,� 3 T �I N R I L E (or) W <br />P operty Ow er's fila" Address � Lot #k Block # Subd. Name or CSM# <br />Cg'p 6 State Zip Code Phone Number , ❑City [] I? 31ol <br />Village Town Iest Roa <br />ry E(2 LJL X01 ( ) ` zT <br />❑ New Construction Use: &Zesidential/Number of bedrooms Code derived design flow rateL,!2PD <br />Replacement �Public or comm rcial — Describe: <br />Parent material 6� Gt K ( Flood Plan elevation if applicable ft. <br />General comments and recommendations: <br />11 Boring # <br />❑ Boring <br />KPit Ground surface elev. ft. <br />Depth to limiting factor' (0 in. <br />Rnil Annliratinn Rata <br />Horizon <br />Depth Dominant Color Redox Description <br />In. Munsell Qu. Az. Cont. Color <br />Texture <br />Structure Consistence <br />Gr. Sz. Sh. <br />Boundary Roots <br />GPD/Ftz <br />*Eff#1 *Eff#2 <br />- 7,5��3/2 <br />S <br />rtiw <br />L„✓ <br />�, <br />2 <br />- LQ ?,r rg 6 <br />_a ,10"116 <br />6 <br />1. <br />Lt�-IIo <br />I-ilv 5- YlIt <br />Boring # <br />❑ Boring, <br />Pit <br />q <br />Grourrd� serrfam etea. ` . S. <br />f <br />DeptPr to firniti g� factor, l O [IT. <br />Roots <br />GPD/Ft2 <br />*Eff#1 *Eff#2 <br />Snil Annliratinn Rafa I <br />Horizon <br />Depth Dominant Color <br />In. Munsell <br />Redox Description Texture Structure <br />Qu. Az. Cont. Color Gr. Sz. Sh. <br />Consistence Boundary <br />Roots <br />GPD/Ft2 <br />*Eff#1 *Eff#2 <br />_a ,10"116 <br />1. <br />I-ilv 5- YlIt <br />CST Na Please Prirt(�., f <br />\F�1 �641%✓) U <br />Signature <br />.CSF N�t� �Lh �� <br />Address <br />Date Evaluation Conduc <br />-aa.( <br />Telephone Number <br />r c6 (6K)- <br />�(r 6HU-8330 (R04/15) <br />