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<br /> wis,Cept.of ts u lain sAtifis son_ EVALUATOON REPORT
<br /> Division of Safe a zul . tui
<br /> ‘ in acco .r•-•..-- -th SPS 385,Wis. Adm. Code
<br /> County BURNETT
<br /> Attach compbte sit ; , a a.,i, mmar,- ri.,maii--,,- ' - 8 1/2 11 inches in size.Plan must
<br /> include,but not j -mita,,§ i 7-Rilyltrefer e ce point(BM),direction and Parcel I.D. 0 7 0(7 6. r72_..1 6 /7/ p
<br /> percent slope,..-soala • . — •- ••-47-. ,.,• . -• '•cation and distance to nearest road. / 63 (.2 0 di
<br /> Please print aid information, evie by 7 Date
<br /> Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). i 6/274)2,
<br /> pp,sity,Owner Property Location -I -
<br /> Li /4
<br /> c-A-I vorry c 0 veni4-Aff c Auc1 Got.Lot ,,..5t2 1/4/t/e71/41 IS T3s N R /7 E(or)VI/
<br /> 7Property Owner's Mailing i_liclq, Lot* Block* Subd.Name or GSM*
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<br /> 115-3e,' 5-7:XV, Ye _ .,......
<br /> !City L i State Zip Code . Phone Number rki Aric Duty pillage Town Nearest Road c.,2,3 a'at-T
<br /> 1 f- A /ea
<br /> IDNew Construction Use:M.Residental/Number of bedrooms 9- Code derived design flow rate GPD
<br /> Replacement Pi.iblic
<br /> 1 onprial-Describe: —
<br /> Parent material aik1/4"P
<br /> Flood Plain elevation if applicable
<br /> Ti. .
<br /> IGenera i comments
<br /> and recommendations:
<br /> ,......._,
<br /> I5 . „ L...1 Bonng
<br /> : B011812'iV
<br /> ! ,pri. Ground surface elev. %g ft. Depth to limiting factor 027 in.
<br /> Soil Application Rate
<br /> ' Horizon 1 Depth ;Dominant Color Redox Description J Texture 1 Structure consistence Boundary Roots GPD/ft 2
<br /> i 1
<br /> in. . Munsell Co.Sz. Cont.Color L
<br /> Gr.Sz.Sh. ' ff#1 11:4,12
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<br /> 1 / —7 IlL.VIZ,4 ...--- /1-5* G.,5 _3 / 4
<br /> LDL_J7 6711 7/571? YY,/ ..._--
<br /> /5 /4,5a ,-2,,.AK-- ys Y/4-(2) /2 46
<br /> k3 a,-3121,53/1/44. e--.21.5Yie-P,s 14.5 i15 ,4 Ac. — /-- _.5" y
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<br /> B no.
<br /> ' ng ii; ....°.,
<br /> oring
<br /> ,....._.....A u Pit Ground surface elev. 7%3 it. Depth to limiting factor..-.?/ in.
<br /> Soil Application Rate
<br /> I Horizon i Depth 1 Dominant Color Redox Description Texture Structure consistence Boundary Roots GPD/ft 2
<br /> an.:
<br /> Mansell Qu.Sz. Cont.Color Gr.Sz.Sh. *Eff#1 *062.
<br /> 1
<br /> LU0— 1 7,.5-yX.-- _ /5'
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<br /> / 7 Ii C
<br /> 1
<br /> 3 ;/:3,91757/4 ....-1.-/n7Aa%ff- /6
<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 /> r CST Name(Please Print) Signature Z) CST Number
<br /> WADE RUFSHOLM Zlie€ 1---/' 227691
<br /> : Address
<br /> Date Evaluation Conducted Telephone Number
<br /> PO BOX 514,SIREN,WI 54872 — g .--a'7°7 (715)349-7236
<br /> 1
<br /> SBD-8330(al,2/21)
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