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es7- ,1-ems <br /> 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. a 7 G 3 2 02 y/ /5/ <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. S /S 0 4/ <br /> 3 e7.2i0 D 0 <br /> Please print all information. Reviewed by `Date <br /> Personal Information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). 1 5h7/2tgq <br /> /Property Owner Property Location 7 <br /> L. AA)of q-G A-L/,) Govt.Lot 1/4 1/4 S a y n N R /jE(or) <br /> i Property Owner's Mailing Address Lot# Block# Subd.Name or G8M#- <br /> 510 33S G o o e,rfn e Ed l � — ,B,4ss L/4-fee A re_ <br /> l City State Zip Code Phone Number Pity Village �Fown Nearest Road <br /> !PLC K/er 1/Al) lsso371 (al�) .77a- 97oy Srv'5cs, ► CA5AiwAy <br /> jNew Construction Use Residential/Number of bedrooms ACode derived design flow rate .3 o C7 GPD <br /> (0 Replacement Public or commercial-Describe: <br /> Parent material 6"/i¢G i A-l d r'; -4/' Flood Plain elevation if applicable art— ft. <br /> 1 General comments <br /> and recommendations: <br /> -TY IQZ26 7 <br /> -_I fl Boring <br /> / ( Boring tt elI C. pit Ground surface elev. 7 ft. Depth to limiting factor •74/ in. <br /> Soil Application Rate <br /> Horizon 0 Depth I Dominant Color Redox Description Texture Structure consistence Boundary Roots GPD/ft 2 <br /> ' 1 in. I Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. *Eff#1 *Eff#2 <br /> / g D^S 7-5fP/ /5 /ss Miter 3� <br /> c 5 (0 .7 /, C <br /> 0 sr-48G 7.3-pe i -- /5 /s,y iv , ,,3 ,moo ,7 /-C. <br /> 43 l 7y o �- sy�y `" s 6 s m / 3><<c, - 7 /, <br /> I , � 6 <br /> r- f Borin # L Boring OnI g IN pit Ground surface elev. /// `/ ft. Depth to limiting factor 7 5 in. <br /> Soil Application Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure :onsistence Boundary Roots GPD/ft 2 <br /> in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. *Eff#1 *Eff#2 <br /> I / O`5� 17,.57,11 .� - 11,-'. /55 /"i* cS J/-a' . 7 /, <br /> i <br /> Lz l 7�7 7.3f/e 7f/ = /S / $5' V r pi -to . 7 1'l <br /> 3 7s 7,53'it i 6s, m / ,,31c ,7 1,4. <br /> 3 <br /> { <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) Signaturee CST Number <br /> WADE RUFSHOLM Z< 227691 <br /> i Address Date Evaluation Conducted Telephone Number <br /> 1 PO BOX 514,SIREN,WI 54872 /y— U (715)349-7286 <br /> T SBD-8330(R11/11) <br />