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Wisconsin Department of Safety and Professional Services/� %Q)NAL Page of <br />Division of Industry Services 1SOIL EVALUAT <br />In accordance with SPS 385, Wis. Adm. Code County * CST -16 `' <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. O 3 ), 9 /j-5 d A 4 6)0 <br />Please print all information. Iview,ate <br />Personal information ou rovide ma be used for seconds purposes Privac Law, s. 15.04 1 mr <br />Property Owner <br />Depth <br />In. <br />Dominant Color Redox Description Texture Structure <br />Munsell Qu. Az. Cont. Color Gr. Sz. Sh. <br />Consistence Boundary Roots GPD/Ft2 <br />*Eff#1 *Eff#2 <br />Property Location <br />0-3 <br />❑ <br />6 e N W <br />Tv 41 <br />3 - S/$ <br />7.5 `r/7 -- <br />Govt. Lot '/4 <br />'/4 S 33' T Z// <br />N R E (or) W <br />Properly Own MaJjpg Address <br />o P <br />'7 1.6 <br />Lot # <br />l `1 <br />Block # <br />Subd. Name or CSM# <br />-7 4j 3�iti <br />,1 Wo- <br />4)r <br />e- -76 <br />75-71? <br />.� <br />Cityy� <br />State <br />Zip Code <br />Phone Number <br />❑ City ❑ Village <br />R1 Town <br />Nearest Road <br />I <br />Ua�C1G�r <br />til' <br />Syg�3 <br />SW/f <br />wv &5 -e L) <br />❑ New Construction Use: ® Residential/Numberofbed rooms -1 Code derived desi gn flow rate 3el17GPID <br />® Replacement ❑ Public or commercial - Describe: > <br />Parent material %!x L./ G.. 1 0" i 1e7 Flood Plan elevation if applicable 1V/X ft. <br />General comments and recommendations: S el w "r 6° e // C/ q O <br />s'r PP %cvry c.el► 1�.4 <br />Boring # ®. Boring <br />❑ Pit <br />Ground surface elev. 9 7 ft. Depth to limiting factor 7d in. <br />Cnil Annlin�+in.. D.�+e <br />Horizon <br />Depth <br />In. <br />Dominant Color Redox Description Texture Structure <br />Munsell Qu. Az. Cont. Color Gr. Sz. Sh. <br />Consistence Boundary Roots GPD/Ft2 <br />*Eff#1 *Eff#2 <br />Texture <br />0-3 <br />--7.n it S <br />--7 1, & <br />Telephone Number <br />-pis- �� 6 4s--7 <br />3 - S/$ <br />7.5 `r/7 -- <br />;'7 /, 6 <br />=� <br />-7 <br />7Syfie %y S <br />'7 1.6 <br />14 <br />3 <br />e- -76 <br />75-71? <br />.� <br />f , <br />7 Boring # <br />Boring R,5-, v%fes <br />Pit Ground surface elev. ft. Depth to limiting factor in. <br />,m�.,.,w.�.,.�. <br />Horizon <br />Depth <br />In. <br />Dominant Color <br />Munsell <br />Redox Description <br />Qu. Az. Cont. Color <br />Texture <br />Structure Consistence Boundary Roots <br />Gr. Sz. Sh. <br />GPD/Ft2 <br />*Eff#1 *Eff#2 <br />Telephone Number <br />-pis- �� 6 4s--7 <br />7 /.6 <br />14 <br />3 <br />e- -76 <br />75-71? <br />.� <br />f , <br />CST Name (Please.PrintSig <br />Jo- S%/ �s <br />lure <br />1Z <br />CST Number - V <br />-7 <br />5 s�/ <br />j a <br />d <br />Address <br />-776 6 h/N- 3S' <br />to Evaluation Conducted <br />S - i -7- /� <br />Telephone Number <br />-pis- �� 6 4s--7 <br />SITU -5330 (R04/15) <br />�''CL S7�Y�' �� 3 <br />