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Ws. Dept Safety and Professkx,al Services SOIL EVALUATION REPORT papof
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� � }.Jac�ordance with SPS 385 'VVis. Adm. Code
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Attach a p4an on paper not less than 8 112 x 11 inches in size. Plan must
Include, but not limited to: vertical and horizontal reference paint (BM), direction and Parcel I.D.
location a distance to nearest road. � V
scent slope, scale or dmne�nsions, north arrow, and loca n and V I
Please print all Info matiom
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PersmW infommMon you prrovWe may be used for secondary purposes (Privacy Law, s. 15-04 (1) MY l �
Property Property Location
Govt. Cot 1/4r � 1 /4 S. T � lei R E {or
Prop70,wnees Maifing Address Lot Black # Subd. or
State Zip Cade 'phone Nunber ❑ y EI Vi a Tern Rarest Road
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New Constnxfion U=111 Residential / Number of bedrooms .12 Code derived design flour rate GPD
0 Replacement [] Public or commercial - Describe:
Parent material ' Flood Plain elevation If apphcable ff.
General c onwents
and recommendations: '
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CZ Pit Ground surface elev. � . ft. Depth to limiting (actor In.
SoU Aonli+cation Rate
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Boring #
Depth t0 ling factor in.
Pit Ground surface elev.
17VUi �+�� lion Rete
Horizon Depth
Dominant Color Redox Description Texture Structure onsistence ndary
Roots GPD/t �
in.
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Efft #1 = BGD > 30 { 220 nV& and TSS >30 < 150 mg/L Bu. u rngfL ana i a3 d-� [TVL
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Address Date Evaluation acted Telephone Number
SBD-8330 (RI 1/t l)
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The Dept. of Safety end Professional Services is an equal opportunity se�ce provider aad employer. If you need assistance to
access s�enr m or need mderW in an alw=te format, contact the department at 608-266-3 I S 1 or T TY ash Relay,
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