Laserfiche WebLink
C,S-r=,2 3- 145 5- <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,Ws. Adm. Code <br /> Attach complete site plan on paper not less than 8 1/2 x 11 inches in size.Plan must County BURNETT <br /> include,but not limited to:vertical and horizontal reference point(BM),direction and Parcel I.D.67 O g vZ 7 9 37 ,S' <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. O O <br /> Please print all information. Revie ed b Date <br /> Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). 3 <br /> Property Owner Property Location 4 c. <br /> R p 6 r-� 6r,n rr Govt.Lot SE 1/4SF1/4 S33 T 3 7 N R 1,6 E(o©' <br /> Property Owner's Mailing Address Lot# Block# Wx-fftne or CSM# <br /> City / State Zip Code Phone Number I 03ity E]Vllage own Nearest Road '70/,2 <br /> t, a cArJ k i m n 1 ( /�) y77-33 t In A` L,e-e... <br /> Rew Construction Use Residential/Number of bedrooms� Code derived design flow rate 3o GPD <br /> Replacement P bli�or m Ler al-Describe: <br /> Parent material G/—A— rni Flood Plain elevation if applicable ft. <br /> General comments <br /> and recommendations: <br /> T <br /> Boring <br /> FBoring# / <br /> Pit Ground surface elev. /p 7. ft. Depth to limiting factor__L/I I/_in. <br /> Soil Application Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft z <br /> in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. * ff#1 * ff#2 <br /> 7 <br /> � R c JP� S <br /> W <br /> Boring# Boring / <br /> Pit Ground surface elev. 7, ft. Depth to limiting factor in. Soil Application Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/fl 2 <br /> in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. * ff#1 * ff#2 <br /> cs 7 >, <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) SignatureCST Number <br /> WADE RUFSHOLM 227691 <br /> Address Date Evaluation Conducted Telephone Number <br /> PO BOX 514,SIREN,WI 54872 v�6 a3 (715)349-7286 <br /> SBD-8330(Rl1/11) <br />