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Wisconsin Department of Safety and Professional Services i J , i ) j, Page of <br />Division of Industry Services 0, 1. 7 <br />SOIL EVALUATION REPORT <br />In accordance with SPS 385, Wis. Adm. Code County n i� <br />Attach complete site plan on paper not less than 8 1 /2 x 11 inches in size. Plan must include, 1`1 <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. <br />Please print all information. <br />Reviewed by <br />Date <br />C , <br />Personal information <br />you provide may be used for secondary purposes Privacv Law, s. 15.04 1 m <br />!� <br />Lo <br />❑ 10 <br />Propert Owner <br />/ <br />Property ation <br />D/a <br />% <br />t(O N R / E (or) W <br />LGovt. <br />Lot <br />/a S' T <br />PrOferty Owner's Mailing <br />Lot # <br />Block # <br />Subd. Name or CSM# <br />� <br />�A1dd//rr�ess <br />` J <br />City <br />St to Zip Code Phone Number <br />❑ City El Village Town <br />LS --I <br />Nearest Road <br />2ooNo-Y Irk61� <br />S 1 q h <br />❑ New Construction Use: A -Residential / Number of bedrooms --�L— Code derived design flow rate _ 5jGPD <br />Replacement ❑ Public or commercial — Describe: <br />1 <br />Parent material C?l C-t A 1. 4% T Flood Plan elevation if applicable ft. <br />General comments and recommendations: <br />Boring # ❑ Boring <br />Pit Ground surface elev. ft. Depth to limiting factor 0 in. <br />Snil Annlinnfion Rate <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/Ft2 <br />-Eff#1 <br />-Eff#2 <br />-CJ <br />��ub <br />Is <br />sL <br />-7 <br />C <br />❑ Boring <br />Boring # Pit Ground surface elev. ft. Depth to limiting factor in. <br />Cnil Annlicatinn 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/Ft` <br />`Eff#2 <br />71 <br />r*Eff#1 <br />V <br />f.0 <br />—4 <br />TQC in <br />< 1 Fn mrin <br />tmuent f 1 = nuv, au = LGu ni <br />CST Name (PieDpdh Burch Signature CST Number <br />AdN CT W a valuation Conducted Telephone Number 16 <br />BD-8330 (R04/15) <br />Spooner, W154801 <br />MP , • <br />• r <br />