Laserfiche WebLink
3 <br /> Burnett County Zoning Administration <br /> BURNETT COUNTY GOVERNMENT CENTER <br /> 7410 County Road K,#102 i Phone(715)349-2138 <br /> Siren,Wisconsin 54872 <br /> SYSTEM EVALUATION REPORT FORM <br /> NAME M wi5- T d <br /> ADDRESS , / <br /> FIRE #/ROAD NAME cip A <br /> LEGAL DESCRIPTION E-s 14 ZSCW7-1- <br /> COMPUTER # <br /> - TANKS <br /> MFG -F-X C. 6') T I SIZE 75D6� <br /> BAFFLE CONDITION OK <br /> MANHOLE COVER CONDMONoil- <br /> COMMENTS LANK p pF /- <br /> n wl T/!r>,/ 41sT ✓ s8i/,cc �1+ d J� '_L� <br /> - DRAINFIELD/DRYWELL <br /> SIZE S' Co' TOTAL SQUARE FEET kA41 <br /> SYSTEM ELEVATION 89. 94 <br /> BENCHMARK z5 Dani oP s -rrt y pap on 51Dk aF a 62 loo.cj�, <br /> - IS SYSTEM: <br /> BACKING UP INTO STRUCTURE /NO <br /> DISCHARGING TO SURFACE /NO <br /> DISCHARGING TO GROUNDWATER OR SURFACE WATER /NO O <br /> - SOIL BORING VERIFICATION (provide on CST Soil Report) <br /> - PLOT PLAN (must provide plot plan showing location of xisting septic tank, <br /> drainfield, well, lot lines and other related setbacks. <br /> - If the existing system is undersized, indicate whether or not a replacement <br /> area is available- ND SoiL E00,LUA-00/o LOAS Dor-AE Foe t?6A 4c(CML- I -C ,14046 -7yV4 ) <br /> J t5WA1E AecA Fire- 56,446 -r7457of REI°LAc6�ItWT So�L ABsOR6Tion) Nr66vi Is AoA144di6 <br /> Name CeaiG N. C'on)Qo�/ Lic. # ,° 2 .290.2. <br /> (please print) <br /> Si nature <br /> g e_�_f 0Date ZOJuAI9 95 <br />