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Wisconsin Department of Safety and Professional Services �:l pRIGINAL <br />Division of Industry Services <br />SOIL EVALUATION REPORT Page <br />of <br />in accordance with SPS 383, Wis. Adm. Code <br />County <br />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 <br />Texture <br />Structure <br />Gr. Sz. Sh. <br />Consistence <br />Parcel I.D. a'7 <br />Roots <br />GPD/ft' <br />percent slope, scale or dimensions, north arrow, and location and distance to nearest road. <br />5-4— <br />3 ea 000 <br />Please print all information. <br />viewed by <br />�` <br />Date <br />Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). <br />uT�/ <br />=C <br />Projpee'rtty Owner <br />Property Location <br />0 <br />0 <br />Govt. Lot <br />1/4 1/4 S% <br />T IVU N <br />R/ 5 E (or) W <br />Property Owner's Mailing Address <br />Lot # Block # <br />Subd. Name o6b19 <br />R1ZdW"; ;4Y .11-0 <br />V �! <br />�2 _37ArP sf <br />- <br />City State Zrp Code Phone Number <br />[]city Village <br />Town <br />Nearest Road <br />-41514L175 r '— <br />lhsc-�- V/ Ile 1,T/V 1 <br />J;9;--K-k,->/J <br />fa <br />ElNew Construction Use i Residential / Number of bedrooms All, Code derived design flow rate d f-) GPD <br />F eplacement (, Public or commercial -Describe: <br />Parent material Flood Plain elevation if applicable /T%}- ft. <br />General comments <br />and recommendations: <br />F/IBoring # <br />Boring <br />10 Pit Ground surface elev. Depth to limiting factor in. <br />Snil Annliration Rate <br />Horizon <br />Depth <br />in. <br />Dominant Color <br />Munsell <br />Redox Description <br />Qu. Sz. Cont. Color <br />Texture <br />Structure <br />Gr. Sz. Sh. <br />Consistence <br />Boundary <br />Roots <br />GPD/ft' <br />'Ef'f#1 <br />'Eff#2 <br />�— <br />Q <br />7 /l �/ <br />�` <br />—C <br />uT�/ <br />=C <br />% <br />f / <br />0 <br />7, d <br />/y <br />i"f <br />! <br />-Gc� <br />17 <br />Boring # Boring C%Q <br />® r Pit Ground surface elev. /v� / ft. Depth to limiting factor in. <br />Snil Annliratinn Rata <br />Horizon <br />Depth <br />in. <br />Dominant Color <br />Munsell <br />Redox Description <br />Qu. Sz. Cont. Color <br />Texture <br />Structure Consistence Boundary Roots <br />Gr. Sz. Sh. <br />GPD/ff <br />'Eff#1 <br />-Eff#2 <br />71 <br />�— <br />Effluent #1 = BOD5 > 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 227691 <br />Address ate Evaluation Conducted Telephone Number <br />PO Box 514, Siren, W154872 (715) 349-7286 <br />%D a <br />SBD -8330 (807/13) <br />