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Wisconsin Department of Safety and Professional Services <br />Division of Industry Services <br />SOIL EVALUATION REPORT Page of <br />in accordance with SPS 383, 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 />include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. U 03 yo /3 S <br />percent slope, scale or dimensions, north arrow, and location and distance to nearest road. j 400 or/ so C>O <br />ZS`tSa <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)). I <br />Property Owner Property Location r-- <br />C <br />Govt. Lot 114 1/4 S <br />T Vo N R 17 E (or) W <br />Property Ow <br />l� i er's Mailing Address <br />Block # <br />Subd. Name or-C6#-- <br />6) !� <br />1�14 <br />Gll^r <br />rp <br />Ffjr.1 <br />State <br />Zip Code Phone Number <br />QVila e , Town <br />9 <br />Nearest Road gS.z Z <br />0� <br />New Construction <br />use i ` <br />Residential / Number of bedrooms <br />Code derived design flow rate <br />SAS GPD <br />&Replacement <br />F <br />Public or commercial - Describe: <br />Parent material <br />/ <br />. / I � ��� f� <br />Flood Plain elevation if applicable <br />/V IA ft. <br />General comments <br />and recommendations <br />0 Boring # <br />Boring <br />Pit Ground surface elev. y ft. Depth to limiting factor ;> ,;�U in. <br />Horizon <br />Depth <br />in. <br />Dominant Color <br />Munsell <br />Redox Description <br />Qu. Sz. Cont. Color <br />Texture <br />Structure <br />Gir. Sz. Sh. <br />Consistence <br />Boundary <br />Roots <br />GPD/ftz <br />*Eff41 <br />*Eff42 <br />�3� <br />�l <br />c <br />w <br />, 6 <br />i <br />Boring # hn Boring <br />i El Pit Ground surface elev. ILI ft. Depth to limiting factor �7� in. <br />Horizon <br />D'ppth <br />jin. <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 />JU11 „GPD/ppllcfR rl "ace <br />*Eff41 <br />*Eff#2 <br />..5 -3"" <br />---- <br />-- <br />--- -• , -_ --- - — Z — I i IVI� ai 1u 1 oo -oe - 1 eu mgiu - tmuent 92 = BOD < 30 mg/L and TSS < 30 mg/L <br />CST Name (Please Print) Signat oeCST Number <br />Wade Rufsholm 227691 <br />Address Date Evaluation Conducted Telephone Number <br />PO Box 514, Siren, W154872 / /g (715) 349-7286 <br />SBD-8330 (R07/13) <br />