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e__$1--c?/—A8 <br /> Wis.Dept.of Safety and Professional Services SOIL EVALUATION REPORT Page of <br /> Division of Safety and Buildings <br /> in accordance with SPS 385,Wis. Adm. Code <br /> Attach complete site plan on paper not less than 8 1/2 x 11 inches in size.Plan must <br /> Com BURNETT <br /> include,but not limited to:vertical and horizontal reference point(BM),direction and p l D d 7 03Z v? y/ /6 9 5 <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. / s- , 5 E 5 pc, <br /> Please print all information. t e* by/ i Date <br /> Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). ♦, 111 <br /> 1' /?/ <br /> Property Or 1 // t Property Location / <br /> El El <br /> R a f1-4-/ K/A) Govt.Lot 1/4 1/7 rT 9/ N R / 6 E(or) <br /> Property Owner's Mailing Address Lot# Block* Subd. . :'. -- <br /> go/3 3.ero 4id c r,�js v Rai5' __ <br /> ity State Zip Code Phone Number <br /> City Village nown Nearest Road <br /> j'in1 e city vnnl s O t3 I (763 W 6V'3 .6 w:s5 I /y 77 <br /> (Vew Construction Use Residential/Number of bedrooms A Code derived design flow rate 3 a C.) GPD <br /> 0 Replacement , Publi orcpmmeIrdal-Describe: .� <br /> Parent material Gr //¢<../GI f',/T t Flood Plain elevation if applicable /t/34- ft. <br /> General comments <br /> and recommendations: <br /> / Boring# 0 Boring <br /> 51 pit Ground surface elev. 9�G ft. Depth to limiting factor . C 0 in. <br /> Soil Application Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft 2 <br /> in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. *Eff#1 *Eff#2 <br /> R 6 <br /> ! � �—� 7,s-�J � --• /�` !/�.sk1� ml,"fir- ‹s 2/'�c-, , 1 /, <br /> a -5---1(- 75Y q4 - /5 //ns6G� , c�%Er ei,s 3f-co , 7 /,6 <br /> �o <br /> 75'1A - _ s c".5.,9 /�/ $ 3 -� ' 2 /,6 <br /> if 7 7� 7v .= , <br /> oC Boring# [Boring / <br /> 0 Pit Ground surface elev. 7f,S ft. Depth to limiting factor g.2 in. <br /> 1 Soil Application Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft 2 <br /> in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. *Eff#1 *Eff#2 <br /> / 0 _6 7,5143, --- /S . —J 7 /, Z. <br /> /9' 7.6Ny` /S 7 i,4 <br /> 7 /Y-67 7- i <br /> ( 6-2,z 7-53#4' % c A d 5y.P 7e Gr-s;/ ------- , r. i E <br /> *Effluent#1=BOD 5>30<220 mg/L and TSS>30 <150 mg/L *Effluent#2=BOD 5<30 mg/L and TSS <30 mg/L <br /> CST Name(Please Print) Signature CST Number <br /> WADE RUFSHOLM - 227691 <br /> Address •ate Evaluation Conducted Telephone Number <br /> PO BOX 514,SIREN,WI 54872 j <br /> �/ —13---aV (715)349-7286 <br /> SBD-8330(R11/11) <br />