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Wis.Dept.of Safety and Professional Services SOIL EVALUATION REPORT f I/- Page_Of <br /> Division of Safe and Buildings c <br /> in accordance with SPS 385,Wis. Adm. Code <br /> Attach complete site plan on p�beF not less than 8 7/2 x 11 inches in size.Plan must County BURNETT <br /> include,but not limited to:vertical and horizontal reference point(BM),direction and Parcel 1 D .57 004. <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. p 4-2151200 <br /> Please print all information. Revi by Date <br /> Personal information you provide may be used for secondary purposes(Privacy Law,s.16.04(1)(m)). <br /> Property Owner Property LocationPe- � <br /> Govt.Lot 5Z5- 1145�,J 1A S f Y T j Y N R / E(or)W <br /> Property Owner's Mailing Address Lot# Block# Subd.Name or CSM# <br /> hyo 38d� Sf <br /> City j Stale Zip Code Phone Number LJCIPY []Vllage own Nearest Road, 09 <br /> ew Construction Use esidential I Number of bedrooms 3 Code derived design flow rate '/fid GPD <br /> Replacement Public ort commercial-Describe: <br /> Parent material U fi4 t—i%� �/i Flood Plain elevation f applicable IIIA ft. <br /> General comments <br /> and recommendations: <br /> Boring# Boring Sy -73' <br /> Pit Ground surface elev. 9 7` ft. Depth to limiting factor ` in. <br /> 11 11 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. 01 ff#2 <br /> ® Boring# Boring <br /> 0 Pit Ground su�ace eiev. q T S ft. Depth to limiting factor 7 7� in. 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 ff#2 <br /> o <br /> -T 7io/66-2 /5 7 <br /> a 6-� �J��e <br /> .7 ao 7,z 7JXf% s o7 114 <br /> 'Effluent#1=BOD 5>30 220 mg/L and TSS>30 <150 mg/L .Effluent#2=BOD 5 30 mg1L and TSS <30 mgfL <br /> CST Name(Please Print) Signature CST Number <br /> WADE RUFSHOLM 227691 <br /> Address Date Evaluation Conducted Telephone Number <br /> PO BOX 514,SIREN,WI 54872 (715)349-7286 <br /> SBI)-8330(RI 1/11) <br />