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Wisconsin Department of Safety and Professional Services <br /> Division of I6dustry 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 8 112 x 11 inches in size.Plan must <br /> include,but not limited to:vertical and horizontal reference point(BM),direction and Parcel I.D. O 7 0-7.2 o7 '// le 3 .5 <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. , C �c Cl 2-2 yS� <br /> j Please print all informations. Reviewed by Date <br /> Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). <br /> I c� <br /> Property Owner Property Location / I - <br /> L/�iDLiE� ��r S Govt.Lot 1/4 114 S Y>-T / N R/ E(or)W <br /> Property Owner s Mailing A dress Lot# Block# Subd.Name er6SAA#- <br /> it G', <br /> City State Zip Code Phone Number F ity Village own Nearest RoadLi <br /> nNew Construction Useo Residential/Number of bedrooms Code derived design flow rate GPD <br /> U�Replacemient n Public or commercial-'DDescribe: - - <br /> Parent material C;-��C)'4 i( ��^i't' f' Flood Plain elevation if applicable ft. <br /> General comoents <br /> and recommendations: <br /> j <br /> I <br /> I Boring <br /> Boring# �/ 7 <br /> Pit Ground surface elev. Depth to limiting factor ! in. <br /> Soil Application Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/f- <br /> in. Munsell Qu.Sz. Cont.Color Gir.Sz.Sh. "Eff#1 `Eff#2 <br /> i <br /> i <br /> Boring# Boring <br /> Pit Ground surface elev. S ft. Depth to limiting factor 7-z in. <br /> Soil Application Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fR <br /> jin. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 *Eff#2 <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) i nature CST Number <br /> Wade Rufsholm G�� �� � 227691 <br /> Address ,ol"Date Evaluation Conducted Telephone Number <br /> PO Box 514,Siren,W1 54872 (715)349-7286 <br /> S--3 D <br /> SBD-8330(R07/13) <br />