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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.O 7 Cl O <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. 0 O <br /> 'lease print all information. ed ¢y Date <br /> Personal information you provide may be used for secondary (Privacy ( )( )) t �O��I ����Y P Y y purposes Privac Law,s.15.04 1 m , <br /> Property Qwner Property Location r--- <br /> tt <br /> k /� Ile-r Govt.Lot Sec,) 1/4iV� 114 S T_3$ N R/ 7 ®r)w <br /> Property Owners Mailing Address Lot# Block# Subd.Name or CSM# <br /> City State Zip Code Phone Number I, ity Village r Town Nearest Road Qyp j <br /> ElNew Construction Use j Residential/Number of bedrooms Code derived design flow rated GPD <br /> Replacement Public or qorrimprcial-Describe: <br /> Parent material `/} G/�} ( � f' Flood Plain elevation if applicable /v } ft. <br /> General comments <br /> and recommendations: <br /> 71Boring# El Boring i <br /> Pit Ground surface elev. ft. Depth to limiting factor ,, 5 in. <br /> Soil Application Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fg <br /> in. Munsell Qu.Sz. Cont.Color Gr,Sz.Sh. *Eff#1 'Eff#2 <br /> Boring# v �G, <br /> Boring <br /> Pit Ground surface elev. 4`� ft. Depth to limiting factor in. <br /> Soil Application Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff <br /> in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. *Eff#1 *Eff#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) Signa CST Number <br /> Wade Ru turfsholm 227691 <br /> Address Date Evaluation Conducted Telephone Number <br /> PO Box 514, Siren,WI 54872 (715)349-7286 <br /> SBD-8330(R07/13) <br />