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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 /> 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 paw I_D. D 7 OR V e? 39 !y /3'.2 <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. o 3 00 0 O <br /> Please print all information. ReviewedL by Date <br /> Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). �'�` �t . /U. i 16/i2/25 <br /> Property Owner Property Location mac-/ ® ki <br /> l G .we,Ai GO.e,I }e-r Govt.Lot „SW 1/4 And 1/4 S`S.--T 3? N R /T E(or)W <br /> Property Owner's Mailing Address Lot# Block# Subd.Name or CSM# <br /> a2/ 7 S beer D'/ <br /> City State Zip Code Phone Number ECi Village Mown Nearest Road <br /> SPo0Ner iWs'V <br /> z- I 'ol I ( ) t'ys I Qeer7ri <br /> New Construction Use Residential/Number of bedrooms a Code derived design flow rate 5/,5-0 GPD <br /> — <br /> 0 Replacement Public or commercial-Describe: <br /> Parent material G IAC- ,4I €d i"1'f' Flood Plain elevation if applicable /✓/' ft. <br /> General comments <br /> and recommendations: <br /> I <br /> I -TGK LD 1 cO2 <br /> / i Boring# [] Boring <br /> pit Ground surface elev. 9 7 ft. Depth to limiting factor 74 in. <br /> Soil Application Rate <br /> 1 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 /> '! o-- 7,3yk; /5 7-33 /)? i s .7i46 .7 /,‘ <br /> 02 .5-727 75Y,Y/9 -- /5 /s m1T!"' ys 3r<eo , 7 /, 6 <br /> .3 ,. ,,�y�� 5 05,5 <br /> ,11/ — _114(6 , 7 4 C <br /> i <br /> Boring# Boring <br /> `I 41 Pit Ground surface elev. / 7 ft. Depth to limiting factor 7-Z.. in. <br /> I 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 /> / OS 75-Y1 /i . /59 ,hd4-- e__s ... , 7 /. L <br /> vZ 5;� 7sy1%y 15 4519 " y 5 y,4,.. , 7 /-6 <br /> .3 0? 702 7 5�,e%6 — 5 os y m/ — y p -2 /-.6 <br /> � l <br /> jP l <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 11.) 4- 227691 <br /> Address Date Evaluation Conducted Telephone Number <br /> PO BOX 514,SIREN,WI 54872 r-6_'S (715)349-7286 <br /> SBD-8330(R11/11) <br />