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Wisconsin Department of Safety and Professional Services <br /> ORIGINAL <br /> DiO R I G I N A L <br /> Division of Industry Services <br /> SOIL EVALUATION REPO <br /> Page <br /> in accordance with SPS 383,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 <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. Parcel I.D. O 7 0- / oZ 3 S j--> <br /> v 9 <br /> - /-?/0 0 <br /> Please Print all Information. Review Date <br /> Personal information you provide may be used for secondary purposes(Privacy Law,a.15.04(1) <br /> Property Owner <br /> Property Location <br /> j<'-✓E' ) El El <br /> a r;6 Govt.Lot 1/4 1/4 S q T38 N R E or W <br /> Property Owner's ailing Address Lot# Block# Subd.Naa aor CSM# / ( ) <br /> / /G 5, LJ1P rsf. l — a 3 <br /> City State Zip Code Phone Number <br /> ity ©Village Nearest Road <br /> e e, Cr finJberl �114rs <br /> New Construction Use ,Residential/Number of bedrooms 3 Code derived design flow rate <br /> GPD <br /> Replacement /� []I Wb11�or collNmercial-Describe: f <br /> Parent material C �%i/}� q�/ i �- <br /> Flood Plain elevation if applicable 1'y 1s' rt <br /> General comments <br /> and recommendations: -L <br /> a�S�7e. C, c=otiRoy <br /> it <br /> Boring# � Boring i <br /> pit Ground surface elev. .:�> ft. Depth to limiting factor vZ In. <br /> Soil plicationRate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF <br /> In. Munsell Qu.Sz. Cont. Color Gr.Sz.Sh. •Eff#1 'Eff#2 <br /> J C - l;� 5 1,07s6t d?/- S /,6 <br /> Boring# ® Boring <br /> Q pit Ground surface elev.�ft. Depth to limiting factor y in. <br /> Soil ADDlication Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF <br /> In. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. •Eff#1 I 'Eff#2 <br /> i <br /> Effluent#1 =BOD >30<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) Signatur CST Number <br /> Wade Rufsholm -ex_z 227691 <br /> Address Date Evaluation Conducted Telephone Number <br /> SPO Box 514,Siren,W1 54872 (7f5)349-7286 <br /> oou-o w(nvfit�J <br />