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Wisconsin Department of Safety and Professional Services Page J_ of 3 <br />Division of Industry Services <br />SOIL EVALUATION REPORT CST— /g -" a <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 slopeParcel I.D. <br />scale or dimensions, north arrow, and location and distance to nearest 'GINA <br />Please print all information. Reviewed Date <br />Personal information you provide maybe used for secondary u oses (Privacy Law, s. 15.04 1 m . S -a3 - <br />Property Owner Property Location ❑ <br />Govt. Lot Y4 �'Y4 S ZS T N R E (or) W <br />Prwner's Mailing Address Lot # Block # Subd. Name or CSM# <br />City State Zip Code ♦ Phone Number E] City ❑ Village j91 Town Nearest Ror� q <br />t _ 1 w _. f _ / 1 . / I i _ _ ..�.�i�i 7 1 _ .. — _ _ _ I I s n 1 n • ! r/ ➢' I <br />[] New Construction User Residential/ Number of bedrooms Code derived design flow rate _J /�PD <br />�j Replacement r Public or comm rcial - Describe: <br />`Parent material �� A r, t G' ` :1 � t Flood Plan elevation if applicable ft. <br />General comments and recommendations: 1 A. <br />Boring # ❑ Boring <br />Pit Ground surface elev. 9-7—A4 Depth to limiting factorZi <br />Snil Annlicatinn Rate <br />Horizon Depth <br />In. <br />Dominant Color Redox Description Texture Structure <br />Munsell Qu. Az. Cont. Color Gr. Sz. Sh. <br />Consistence Boundary <br />Roots <br />GPD/Ftz <br />`Eff#1 -Eff#2 <br />7+ 3 <br />Gs <br />ZF <br />239 <br />7. yL)AI984( <br />_ <br />y-1 <br />7, <br />..vl --- <br />�- <br />Boring # ❑ Boring X7Z � <br />Pit Ground surface elev./ 7r Depth to limiting factor i / vj('� <br />0 <br />Rnil Annlinntinn Rata <br />��uu�aur:ar�ct�ur�ct•��i�uuuurl•f��1��72GVL7Ml•�/�6/1���11•f��lbfti�l�l��f1•G�/I•�iil ll�rTi�AX"�ZI•Ci4l•r::T71- <br />C T Nre P ease Print) <br />Dominant Color Redox Description <br />Munsell Qu. Az. Cont. Color <br />Structure <br />Gr. Sz. Sh. <br />Address // <br />Q L G <br />Date Evaluation C duct <br />Telephone Numb r <br />_ r.:iir� <br />_ <br />��uu�aur:ar�ct�ur�ct•��i�uuuurl•f��1��72GVL7Ml•�/�6/1���11•f��lbfti�l�l��f1•G�/I•�iil ll�rTi�AX"�ZI•Ci4l•r::T71- <br />C T Nre P ease Print) <br />Sign <br />11L <br />OVI <br />CST u er <br />N <br />IOZZ <br />Address // <br />Q L G <br />Date Evaluation C duct <br />Telephone Numb r <br />'Tee -go )A`r_/ .t/03.7 - SBD -8330 (R04/15) <br />