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WI's.Dept.of Safety and Professional Services SOIL EVALUATION REPORT <br /> Division of Safety and Buildings Page_of <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 <br /> percent slope,scale or dimensions, north arrow, and location and distance to nearest road. Parrcce_l I.D. 0 7 466 <br /> 3 0v <br /> Please print all information. Reviewed bv, Date I / <br /> Personal information you provide may be used for secondary purposes(Privacy Law,s. 15.04(1)(m)). <br /> Property OwTr Property Location <br /> Govt. Lot 1/4 1/4 S �/ TV/ N R 5 E(or) <br /> Property Owner's Mailing Address ; uity <br /> Block# Sbd.Name <br /> City State Zip Code Phone Number ❑village own Nearest Road <br /> y997 5'cu,�5�5 7,--/ <br /> ❑ New Construction Use Residential/Number of bedrooms Code derived design flow rate GPD <br /> ❑Replacement /� E] Publicor gommerat-Describe: <br /> Parent material l �/¢C j�¢/ �/` '( Flood Plain elevation if applicable <br /> General comments I `/��[ <br /> and recommendations: Ol //o u s <br /> (� <br /> CZ- <br /> Boring# Boring ^ <br /> lel pit Ground surface elev.�/ly ft. Depth to limiting factor_in. <br /> Soil Application Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence r8oundary Roots GPD/ft 2 <br /> in. Munsell Qu.Sz. Cont.Color Gr.Sz. Sh. ff#1 Eft#2 <br /> 6Z5-M' C�� s- �- , 9 <br /> F-1Boring# Boring <br /> ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure 7,onsistence Boundary Roots GPD/ft 2 <br /> in. Munsell Ou.Sz. Cont.Color Gr. Sz.Sh. ff#1 * ff#2 <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) Signature� / CST Number <br /> WADE RUFSHOLM tet, 227691 <br /> Address Date Evaluation Conducted Telephone Number <br />