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Wisconsin Department of Safety and Professional Services CU 1 — , Page of <br />Division of Industry Services <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, 3� ✓ N <br />but not limited to: vertical and horizontal reference point (BM), direction and percent slope, Parcel I.D. C27- 0,A0--,A- YO - /(per 33 C j <br />scale or dimensions, north arrow, and location and distance to nearest road. o 00 0i r/ 0 <br />Please print all information. Reviewed by 1 n ( Date <br />Personal information you provide may be used for seconds purposes Privac Law, s. 15.04(1) m ). LU /j y� ZZ— <br />Property Owner Property Location ❑ <br />,' C v y h 13 if 1 /e. o GQ Govt. Lot '/4 % S ? T "/C N R E (or) W <br />Property Owners Mailing Address Lot # Block # Subd. Name or CSM# <br />I> c !3« k '5" 6 -j 2 V, (G ? // e/ <br />City State Zip Code Phone Number ❑ City ❑ Village © Town Nearest Road <br />Web st-ev I W.z 1 szry 3 I (as 1 t 1 C-IC-/4114 C e-Ve5 iZW <br />® New Construction Use: ® Residential/Number of bedrooms 3 Code derived design flow rate Y3 G GPD <br />❑ Replacement // El Public or commercial — Describe: <br />Parent material C- t c, j 0r r t^Y Flood Plan elevation if applicable/ V� ft. <br />General comments and recommendations: <br />Boring # ❑ Boring <br />Pit <br />9&,v <br />Ground surface elev. ft. Depth to limiting factor In. <br />Cnil R.tc <br />Horizon <br />Depth <br />In. <br />Dominant Color <br />Munsell <br />Redox Description <br />Qu. Az. Cont. Color <br />Texture <br />Structure <br />Gr. Sz. Sh. <br />Consistence <br />Boundary <br />Roots <br />GPD/Fe <br />*Eff#1 <br />*Eff#2 <br />1 <br />0 -� <br />�'/ <br />— <br />Is <br />/M <br />.7 <br />, 6 <br />�j-��t <br />7Sti�Z 4"/y <br />_ <br />iFS <br />"'S <br />6— <br />/,U <br />'y Msb /c <br />_7 <br />r, 6 <br />y0-y'1 <br />7,5"ti12�/ry <br />— <br />v1=ls <br />r»s6/z <br />,v, I <br />S <br />"7�'-i <br />,y <br />F <br />5­1 Boring # <br />❑ Boring C16 5� '7 L <br />® Pit Ground surface elev. ft. Depth to limiting factor 7 in. <br />Gnil Annlirntinn Rata <br />Horizon <br />Depth <br />In. <br />Dominant Color <br />Munsell <br />Redox Description <br />Qu. Az. Cont. Color <br />Texture <br />Structure <br />Gr. Sz. Sh. <br />Consistence <br />Boundary <br />Roots <br />GPD/Fe <br />*Eff#1 <br />*Eff#2 <br />- t1 <br />?,S "//r 3/ <br />/ S <br />m s 4 is <br />1 <br />C s <br />-7 <br />j. 6 <br />76 <br />�31ifte i7�:3e:i�ns�cirsa*r��m��cliri rrwt�cuc�w1rmA�M:iIRa:I�:�8:i�1�i7ti�C1�yJ�fiiTil/FliTi <br />CST Name Name (Please Print) <br />�C� by 1 , C /S. <br />Signature <br />t 4w - /—)C <br />CST Number <br />3 Z/0 <br />Address /fu..y 3S— <br />Date E luation Conducted <br />Telephone Number <br />SBU-8330 (R04115) <br />