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Cs7=;s 8'7 <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 /> 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.07 6/2 2 Ye' Is- /V '/ <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. 0 0,0 0 my C> <br /> Please print all information. Revie d b Date <br /> Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). 1 C/27/"f <br /> Property Owner Property Location ,OG 111 ? <br /> ❑Zdkr`re_r) `j 0 re- Govt.Lot /OJWJ 1/45F1/4 S /y T VD N R/S E(or)WW� <br /> Property Owner's Mailing Address Lot# Block# Subd.Name or CSM# <br /> City / State Zip Code Phone Number City Village Town Nearest Road ,3vs / <br /> •U A.�J b'� orr y ,�ye3o 1 ( )771-07-1Z T Z'1)-L< .Z 5 0.3 1 G h 4!e* V <br /> New Construction Use-Residential/Number of bedrooms (-2. Code derived design flow rate 3 0 d GPD <br /> Replacement 0 Public or commercial-Describe: <br /> Parent material G-/,4 C. A--I d r../1 f't Flood Plain elevation if applicable ft. <br /> General comments <br /> and recommendations: <br /> El Boring <br /> Boring# g7 5-- <br /> 11 pit Ground surface elev. / 0 ft. Depth to limiting factor >7. 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. *tff#1 *Eff#2 <br /> o -.6-' 7,57134. _______ /5 - . -- . 7 /,.Z <br /> a A/ 7&74'r/ -- _ /- _---- , 7 /,‘ <br /> 3 I7ZZ 7 6704 — s /.- <br /> Boring# Boring <br /> Pit Ground surface elev. ft. Depth to limiting factor 7/ in. I 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 /> / c -G 7,A? e---- •s /n_50 .nd -- .s .77'-eo , 7 A 6 <br /> 3 ?/ 751,Py/6 - s 03) .),/ -- 3Ke_c. . 7 /.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 /> CST Name(Please Print) Si nature CST Number <br /> WADE RUFSHOLM 227691 <br /> Address Date Evaluation Conducted Telephone Number <br /> PO BOX 514,SIREN,WI 54872 Z.,-o.62 a37 (715)349-7286 <br /> SBD-8330(Rl 1/11) <br />