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• <br /> W aid: I e‘szZ <br /> Wis.Dept.ip an �'Fo esslona ern SOIL EVALUATION REPORT Page of <br /> Division ofnd Buildings <br /> in nce with SPS 385,Wis. Adm. Code <br /> I 1 i County BURNETT <br /> Attach cosite plan on paper not les 8 1/2 x 11 inches in size.Plan must ® V /g <br /> include,but not Irmited to:v {{� ntal reference point(BM),direction and Parcel I.D. D 7 <br /> percent slppe,scale or dini`etis4 6 t{ rth arrow, location and distance to nearest road. 1 O Landaervicesu and a <br /> `eI5artmert `� D6Q >I C 7 C) <br /> Please print all intormation. Reviewed by Date <br /> Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). C�N��( 1 7/iZ`' 1 <br /> Property Owner Property Location 75 o o1 e— <br /> �l/A e KN Kos.)o ry Govt.Lot SE 1/4,t/1/4 S 3,2 T37 N R 1 7 E(or)1171. <br /> Property Owner's Mailing Address Lot# Block# Subdrhlame or CSM# ,$2/2 43e34 e, <br /> S69 <I sttyecoi9-c! Tr ,.) 7 a9' pp8c> <br /> City State Zip Code Phone Number ❑City Village own Nearest Road a,5080 <br /> el/Gad—el' 1/n 155412► (45/) Y30-1 5170 GJ. inA-1%,5 //4-,t,d 17 )/A) oAKS741 <br /> ❑ New Construction Usei Residential/Number of bedrooms Code derived design flow rate GPD <br /> Replacement ❑ Public or commercial-Describe: <br /> Parent material C7/, .c j,-1 d/`7 1 7` Flood Plain elevation if applicable ft. <br /> General comments <br /> and recommendations: <br /> 01.*/*Ae'4Se.. 0,4)/7 <br /> 5.Boring <br /> Boring# 9Q <br /> Pit Ground surface elev. f + ft. Depth to limiting factor 7r7 in. <br /> Soil Application Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots . GPD/ft 2 <br /> in. Munsell <br /> Qu.Sz. Cont.Color Gr.Sz.Sh. *Eff#1 *Eff#2 <br /> 02 $ 7 7.qie% /S _ -- , 7 /,‘,*3 a7-Ia 7,� � 6 -...— s - - - . - _._,_____ . 7 /. <br /> Boring# ❑ Boring <br /> ❑ Pit Ground surface elev. ft. Depth to limiting factor in. 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 /> *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 CST Number <br /> WADE RUFSHOLM G_ ---- 227691 <br /> Address Date Evaluation Conducted Telephone Number <br /> PO BOX 514, SIREN,WI 54872 6--3 -. .2 V (715)349-7286 <br /> 7 SBD-8330(RI1/11) <br />