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Wisconsin Department of Safety and Professional Services l OCT 17 2023 P ge of <br /> Division of Industry Services <br /> SOIL EVALUATION REPC RT Burnett County <br /> nd Services Department <br /> In accordance with SPS 385,Wis. Adm. Code ounty <br /> Attach complete site plan on paper not less than 8 1/2 x 11 inches in size.Plan must include, <br /> but scaleoorlmited to:dimens dimensions,north acal rrow,anndtal reference loca ion and distanint ce t nearest road.on and percent slope, �P7r-0e ID.� yp,_fy_�r ci L1 0 l -pet? 014 c CO <br /> Please print all information, le ed b Date <br /> Personal information you provide may be used for secondary purposes Privacy Law,s.15.04(1)m). �D/eZ71;-L3 <br /> Property Owner Property Location 2 <br /> S t- u(t (f Ov I'l Govt.Lot V4 1/4 S 9 T y Q N R E (or) W <br /> Property Owner's Mailing Address Lot# Block# Subd.Name or CSM# <br /> PO k3cx 35- 2 [/. l'� P �3c? <br /> City State Zip Code Phone Number ❑cit <br /> y ❑Village �Town Nearest Road a.�- <br /> /U eW. /9LA r� Wj .fit 7J-7 ?/5- Slr7 I ISC 0 7 , <br /> O[y'i <br /> Fj New Construction Use:Ej Residential/Numberofbed rooms_ Code derived design flow rate 300 GPD <br /> Replacement ❑Public commercial-Describe: <br /> Parent material- G'1,-G��( /� � Flood Plan elevation If applicable ply ft. <br /> General comments and recommendations: <br /> Sys: <br /> F-/ 1Boring# ❑Boring 1 � <br /> Pit Ground surface elev� ft. Depth to limiting factor in. <br /> ' Soil A plication Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GRcatio <br /> In. Munsell Qu.Az, Cont.Color Gr.Sz.Sh. <br /> *Eff#1 <br /> 0-`V. 7.5%? ��ti — *Eff#2 <br /> 5`$ �.S`1[-7 u l y I S rn sd/c lM 1 l= S o 17 /, ,6 <br /> Y), 7-5-VI-1 5/2 5 vS l <br /> v� 1 ,�n� -7 /. <br /> Boring# ❑Boring 9� y 7) <br /> Pit Ground surface elev. ft. Depth to limiting factor in. <br /> --T7 <br /> Soil Ap lication Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/Fe <br /> In. Munsell au. <br /> Az.Cont.Color Gr.Sz.Sh. <br /> *Eff#1 -,v*Eff#2 <br /> C-W 7 5- � /S j.� 7 <br /> `1- -0 7 S'1/7 y — /S Jm 5,61 /z <br /> *Effluent#1 =SOD,>30 5 220 m /L and TSS>30 5 150 mg/L *Effluent#2=SOD,>30 5 220 mg/L and TSS>30-5150 m /L <br /> FCS-SJ <br /> S uT Name(Please Prints l l Sign e CST Number <br /> ')c�in 6S ,-e/ S /Jn C ; -73 L/a4 (/ <br /> Address ,1 77rnC/ -7 S Da Evaluation Conducted Telephone r <br /> lti-t5 S�rL- Wr SZf fYi3 `'t - `3- ,/ 7/5- � <br /> SBD-8330(R04115) <br />