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CSf-2 3o ORIGINAL <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. 0 7 0 3 R a y//6. a percent slope,scale or dimensions,north arrow,and location and distance to nearest road. is.- 7/e. 6/C OaA <br /> Please print all information. Reviewed by Dale U Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). `'1c I I(t. 1 5t t as I <br /> Property Owner Property Location <br /> LA )o) *CA-`/ ) Govt.Lot 1/4 1/4 Sa g T elf N R /� E(o® I <br /> ,t <br /> Property Owner's Mailing Address Lot# Block# Subd.Name erCSM#— <br /> Y6335- GouermeAlf. id 6 r/6o% Al0 afr. sae' <br /> City State Zip Code Phone Number OCity ®Village Elcown Nearest Road 77 2 5 <br /> 117ac.k/e y 4rrlid I5S037 1 (oZ/9 )370-970 V S'W i5 5 I 0.4 k. 5Y- <br /> .New Construction Use Residential/Number of bedrooms .2 Code derived design flow rate se O GPD <br /> 0 Replacement /� D Public or co mercial-Describe: <br /> ( <br /> Parent material /A-G IA-6/ ri-r-t- Flood Plain elevation if applicable /t1/4 ft. <br /> General comments <br /> and recommendations: <br /> 0p42./0 -F,eJ <br /> d <br /> �" -T&L L . tSC tl <br /> / Boring# u Boring �y <br /> { ix <br /> Pit Ground surface elev. qd 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. *Eff#1 *Eff#2 <br /> D-/ 7,syk 5rz. /.S 155 /Yi Jfr' 3 S .11-fil , 7 1,6 <br /> aZ /aZ" / 7,514 °�6 Gt.-5 0s y rnAer 9.5 23G•- . 7 /'4 <br /> 3 r/-7oz 741e% -- S ©sy /49/ — — / 7 /.6 <br /> 0 Boring <br /> Boring# q�O�t / <br /> ra-1 <br /> 'Pit Ground surface elev. / ' / ft. Depth to limiting factor 7.5' in. <br /> I Soil Application Rate <br /> • <br /> Horizon Depth Dominant Color Redox Description Texture Structure consistence Boundary Roots GPD/ft z <br /> in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. *Eff#1 *Eff#2 <br /> / 0—// 7.5JR '/ — /5 / S 3 mu 24r gs ,'i4-"t , 7 /. 6 <br /> z 4-53 7,5r7R 574 — Gr-5 os 3 _ mtW' 3 5 - . 7 /•G <br /> 3 '53-75icp % S 0.5.5 , / . - — , 7 7, 6 <br /> I <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 i, CST Number <br /> WADE RUFSHOLM A) 227691 , <br /> Address Date Evaluation Conducted Telephone Number <br /> PO BOX 514,SIREN,WI 54872 3 -al/ (715)349-7286 <br /> SBD-8330(R11/11) <br />