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r--) I' ' C E 0 V' E M <br /> 'F fi� h C�JT 2S`�3 / <br /> ' Wis.Dept.of Safety and Professional Services SOIL EVALUATION REPORT Page of <br /> Pi p. g <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 /> .,w- include,but not limited to:verticaland horizontal reference point(BM),direction and Parcel I.D. 6 7 a 3a a y/ /S- t r S <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. a y 0 pa 0/7 oc,D <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)). / ,�L� !/ ,, 1'z/ii 26 <br /> Property pwner Property Location <br /> j v e_et) I. LfA/d e r V/7/e- Govt.Lot a 1/4 1/4 S/ T 9/ N R /SE(or)Wi°' <br /> Property Owner's Mailing Address Lot# Block# Subd.Name or CSM# <br /> 65'7 (2 - a7''4 571- - <br /> City State Zip Code Phone Number EiCity ®yiIlage Mown Nearest Road 3/O 7S <br /> /?letv/4-4Cu 1G 1 .5�7'S'7i (7/5-) Fr'75.8/ S6v!S5 IA),B45S L/< <br /> ® New Construction Use Residential/Number of bedrooms Code derived design flow rate GPD <br /> ®Replacement Public orcommercialGIP <br /> /`P/y Flood Plain elevation if applicable ft/4,1 ft. <br /> General comments Sandi eab&n de poSlf> <br /> and recommendations: O U74O u 5 e ©i✓/y <br /> ir.iv,1 04.044 title 4-0 - teed 118 i nags fl 0( l D 2/430 <br /> Boring# Boring Pit Ground surface elev. 9 /q G ft. Depth to limiting factor O y in. <br /> Soil Application Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots I GPD/ft 2 <br /> in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. *Eff#1 *Eff#2 <br /> I ©--� 7,.5Yi-A L5 . 7 i,G <br /> -s-17 7,57,,, - %s ,) l ,L <br /> .3 /1-5Y 7.5 'i s - . 7 r, <br /> Boring# ® Boring <br /> ® Pit Ground surface elev. ft. Depth to limiting factor in. <br /> 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 /> *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 a.e,/,,, 227691 <br /> Address Date Evaluation Conducted Telephone Number <br /> PO BOX 514,SIREN,WI 54872 /a_9-as (715)349-7286 <br /> SBD-8330(R11/11) <br />