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Wisconsin Department of Safety and Professional Services �� <br />Division of Industry Services C, y <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 8 112 x 11 inches in size. Plan must <br />include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. 07 O/ ff -7 - /d i� 3 <br />percent slope, scale or dimensions, north arrow, and location and distance to nearest road. v 000 olleq&hn <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)), %� 7 Z� . <br />Property Owner Property Location r - <br />Govt. Lot �6 1 /4,001 /4 S / j T3 N R ®r) W <br />Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# <br />76 3j Ct-m Pte AV - <br />Jta>e up was rnone Ivumner <br />tY (._ 9 <br />LF1i Village Town <br />Nearest Road 6 $$o <br />Si/`enJ w� <br />PE <br />/ <br />ew Construction <br />Useo Residential / Number of bedrooms <br />Code derived design flow rate <br />GPD <br />Replacement <br />El Public or ornm- De tribe: <br />Parent material <br />Cir)ercial <br />r 7�iH "w /- / <br />Flood Plain elevation if applicable <br />�, <br />Al/ 14 <br />General corn rents <br />and recommendations <br />Boring # <br />Boring <br />Ground surface elev. �_ <br />Pit 7 ft. Depth to limiting factor --5�6 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/fir <br />*Eff#1 <br />I *Eff#2 <br />70�S <br />..% <br />i <br />Boring # Li Boring <br />1121 pit Ground surface elev. ft. Depth to limiting factor --5—Z_ in. <br />Horizon <br />Depth <br />lin. <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/fly <br />*Eff#1 <br />*Eff#2 <br />s <br />rn <br />f�i�✓` <br />o <br />, s <br />, 9 <br />! <br />r=inucii m 1 — ovv, � JU � LGV mg/L ana I JJ >3U < l bU 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 Date Evaluation Conducted Telephone Number <br />PO Box 514, Siren, W154872 (715) 349-7286 <br />sBli-ussu (tcu // t.s, <br />