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Cs-= a5-I9 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 /> 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. 7 v <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. j Ovtj <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)). <br /> Property Owner Property Location <br /> ,[ ,0J GA C �� Govt.Lot 1/4 1/4 S �b T y0 N R /�E(or® <br /> Property Owner's Mailing Address 9;�;, <br /> # Subd.Name-orCSN� <br /> City State Zip Code Phone Number llage own Nearest Road <br /> I In Id 5 �ee�' )6A55 <br /> New Construction Use- Residential/Number of bedrooms�7 Code derived design flow rate o© GPD <br /> ly—Replacement Public or commercial-Describe: <br /> Parent material f'4e_ Flood Plain elevation if applicable /'1J A ft. <br /> General comments <br /> and recommendations: <br /> i <br /> `I Clk lD $ <br /> q Boring# El Boring <br /> E <br /> !` 0 Pit Ground surface elev. z_ft. Depth to limiting factor 7-7 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 1.02 <br /> -2 6= 7, ,�y - is <br /> i <br /> R <br /> q i <br /> d I <br /> nBoring# Boring <br /> Pit Ground surface elev. 477, ft. Depth to limiting factor in. Soil Application Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure 3onsistence Boundary Roots GPD/ft 2 <br /> in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. ff#1 ff#2 <br /> l 0--6' .P 5 /'� <br /> o2 6 30 7,JoMy S 23 ;7 <br /> i <br /> Effluent#1 =BOD 5>30 5 220 mg/L and TSS>30 <150 mg/L Effluent#2=BOD <30 mg/L and TSS <30 mg/L <br /> CST Name(Please Print) Signature CST Number <br /> WADE RUFSHOLM 227691 <br /> Address Date Evaluation Conducted Telephone Number <br /> i PO BOX 514,SIREN,WI 54872 c]! _ (715)349-7286 <br /> SBD-8330(RI1/11) <br />