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Wisconsin Department of Safety and Professional Services <br />Division of Industry Services <br />SOIL EVALUATION REPORT Page of <br />in accordance with SPS 383, Wis. Adm. Code Cs f' <br />Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County ell <br />include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D o 7- OD 'd- V19 7`s � S - <br />percent slope, scale or dimensions, north arrow, and location and distance to nearest road. 9 yU , U 4/q0& <br />Please print all information. Rev' ed by Date <br />Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04(l) (m)).— <br />Property Owner Property Location <br />Lnj <br />Govt. Lot 1/4 1/4 S -7 T 4/0 N R J E (or) W <br />Property Owner's Mailing Address A �/ Lot # Block # Sub . N e or CSM# <br />W 7� 1 L Cal w LG O� f't U r✓' 416 <br />a N /o <br />City State Zip Code Phone Number ity 17Ullage VITown Nearest Road 3yiv% <br />h12 is 4 I / Z I 9 1 ( ) SCS I J'14r'd tiles c, 6 -e rr, /�W <br />Ri New Construction UseM Residential / Number of bedrooms 3 Code derived design flow rate ��� G' GPD <br />Replacement Public or commercial - Describe: <br />Parent material / /fit^ i `f Flood Plain elevation if applicable /�%%� ft. <br />General comments 6,lys C -,A f1 le , (7,:;= O <br />and recommendations: rv, 9ef.7 <br />Boring # <br />Boring <br />FT] <br />Pit Ground surface elev. '17e 1 ft. Depth to limiting factor 1 '70 in. <br />Horizon <br />Depth <br />in. <br />Dominant Color <br />Munsell <br />Redox Description <br />Qu. Sz. Cont. Color <br />Texture <br />Structure <br />Gr. Sz. Sh. <br />Consistence <br />Boundary <br />Roots <br />GPD/ff <br />*Eff#1 <br />*Eff#1 <br />I *Eff#2 <br />v- (` <br />7, s"//Z <br />? 5 `11e <br />/j <br />/rh s4 k <br />.s5le- <br />rr, l <br />C3 <br />3 / <br />, 7 <br />1,6 <br />l��Sa <br />3=51 <br />7S` Z <br />)nIjob/< <br />/10 <br />L-Vf �, <br />%ice m 411A <br />/� <br />%j JJ� <br />51 7 <br />'7 s`WR <br />-- <br />IJ=S <br />,)M,s4/< <br />Boring # �— Boring 7. <br />Pit Ground surface elev. ft. Depth to limiting factor -741 in. <br />Horizon <br />Depth <br />in. <br />Dominant Color <br />Munsell <br />Redox Description <br />Qu. Sz. Cont. Color <br />Texture <br />Structure <br />Gr. Sz. Sh. <br />Consistence <br />Boundary <br />Roots <br />GPD/ff <br />*Eff#1 <br />I *Eff#2 <br />I <br />v- (` <br />7, s"//Z <br />/j <br />/rh s4 k <br />7 <br />l��Sa <br />-7,s�/1? <br />/10 <br />%ice m 411A <br />4,4 <br />51 7 <br />'7 s`WR <br />-- <br />IJ=S <br />,)M,s4/< <br />L UVI Il tt I - 0%-JL/5 - 3U2:/ -/V IIly/L anU I ao you � IOU mg/u - Muent P2 = 130135 :< 30 mg/L and TSS < 30 mg/L <br />CST Name (Please Print)/ll n Signature CST Number <br />jA- 1", ,, s .S Ute. e71 -e -S 73 �l� 0 <br />Address Date Evaluation Conducted Telephone Number <br />7 76 O �,C.- I� � tV e /J -,Irl 111 �/i�Y �3 // 3' /7 7/,.5-- 7 <br />SBD -8330 (807/13) <br />