Laserfiche WebLink
Wisconsin Department of Safety and Professional Services <br /> Division of Industry Services C l ✓cv.'`9 <br /> SOIL EVALUATION REPORT Page of <br /> in accordance with SPS 383,Wis. Adm. Code <br /> County BURNETT <br /> Attach complete site plan on paper not less than 8 1/2 x 11 inches in size.Plan must <br /> include,but not limited to:vertical and horizontal reference point(BM),direction and Parcel I.D. (3 7°1°1 a r71"6 /35-7,c <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. <br /> /S"' azo csm27ooc) _/,3 <br /> 111, <br /> Please print ail information. Reviewed by ) Date <br /> Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). L. 13• •ZJ 'Ztl <br /> 1 Property Owner Property Location <br /> 7�o/n AournJ 0 129- <br /> Govt.Lot 1/4 1/4 S/3 T y0 N R/� E(or)W <br /> Property Owner's VMailingddress Loto # Block# Subd.Name+ orGSM# <br /> Cityal 0 0 1/37State if VeL /7 1/-41-fmoat)c�iJ ). -o14 <br /> I kp Zip Code Phone Number Oily Village ; N own Nearest Road,as j 7S- <br /> 0 e 45 1 W.V15'i<Qa3 1 (7/s')..5-79,--g 27S' iq-c 5 oyJ 11641. nvevu c_i'- <br /> 0 New Construction Use° Residential/Number of bedrooms 171 Code derived design flow rate 8 C7 GPO <br /> .Replacement Public r commercial-Describe: �. <br /> Parent material 17lA"G/�A-t �/�� Flood Plain elevation if applicable `✓,'i ft <br /> General comments <br /> and recommendations: <br /> I <br /> I Boring# IA, Boring G� '7�7 <br /> I pit Ground surface elev. % ft. Depth to limiting factor �//. in. <br /> Soil Application Rate <br /> 1 <br /> Horizon Depth Dominant Colori Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 <br /> 1 in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. *Eff#1 *Eff#2 <br /> ____l �0-5 7,sre `� /S , >,4 <br /> �s-.30 7,,5 A `�/ — s 7 <br /> 3 0-7,z7`5gy6 , 5 , 7 A4 <br /> ic21 <br /> Boring# Boring <br /> ;gam Pit Ground surface elev_ ft. Depth to limiting factor.->7/ in. <br /> l Soil Application Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fr <br /> in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. <br /> O'_� 7/53/e3-- �_ .. _ *Eff#1 *Eff#2 <br /> /S /rlts6t m a� --5. .3/-Z-o i2 /,4 <br /> 25 brat 3 7/ 75-on /ntJF 9 7 j/� <br /> _5 0.5 g /1, / , -ca i /' <br /> I <br /> *Effluent#1 =BOD,>30<220 mg/L and TSS>30<150 mg/L *Effluent#2=BOD,<30 mg/L and TSS<30 mg/L <br /> CST Name (Please Print) / Signature <br /> Wade Rufsholm CST Number <br /> Address 227691 <br /> F®Box 514, Siren,WI 54872 Date Evaluation Conducted Telephone Number <br /> - ��--�/ (715)349-7286 <br /> SBD-8330(R07/13) <br />