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c�T a - 1 `IZ <br /> Wis.Dept.of Safety and Professional Services SOIL EVALUATION REPORT Page j__^ <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 Q✓Z 41 6 9 <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. 0 4g Q Q <br /> .Please print ail information. a 'e d b Date <br /> Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). <br /> I Property Owner Property Location ( <br /> PRN/ t?cp($ Ic�, Govt.Lot 1/4 1/ S,91 T Y6 N R 1,6 E(or)Wl":' <br /> Property Owners Ma dress Mailing A Lot# Block# Subd.Name or6GW <br /> 137 a D141A11 D itaa iU 1 <br /> I City State Zip Code Phone Number OCity K; ..villag own Nearest Road 53 f o;s <br /> /-q ss/fay N� 1' �k �y- <br /> Never Construction Use Residential!Number of bedrooms 3 Code derived design flow rate C� GPD <br /> eplacement Public or miner 'al-D scribe: <br /> Parent material �- fr/ r Flood Plain elevation if applicable ft. <br /> General comments <br /> and recommendations: <br /> E <br /> a <br /> 3 <br /> V <br /> Boring <br /> s / Boring# 7� <br /> L _ 17 Pit Ground surface elev. it. Depth to limiting factor / 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. ff#1 * ff#2 <br /> 7 <br /> rj <br /> 1-3 <br /> ! I <br /> s <br /> i <br /> i <br /> I <br /> F] Bonin p <br /> Boring g 7 P 9 l � i Pit Ground surface elev. ft. Depth to limiting factor m. <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. *1 NMI * ff/#2 <br /> I / <br /> i I <br /> I y <br /> I <br /> Effluent#1 =SOD 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) Signatu CST Number <br /> WADE RUFSHOLM ' 227691 <br /> Address Date Evaluation Conducted Telephone Number <br /> PO BOX 514,SIREN,WI 54872 /� � (715)349-7286 <br /> y SBD-8330(RI1/11) <br />