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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. ® 7 0,2 0 yG 7 �{ <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. 0 ";� (,) <br /> Please print all information. Date <br /> Personal information you provide may be used for secondary purposes(Privacy Law,s.15,04(1)(m)). JrW <br /> � ) �I <br /> Pro ertyjOwner Property Location !-- <br /> Govt.Lot 1/4 4/S T C N R f ®r)W <br /> Property Owner's Mailing Address Lot# Block# Sew-Narne or CSM# <br /> City State Zip Code Phone Number i ❑Villa e wn Nearest Road ? T <br /> �,,. y, �— ty �---, g / y <br /> New Construction Use Residential/Number of bedrooms Code derived design flow rate G c;� GPD <br /> Replacement Public or commercial-Describe: <br /> Parent material Flood Plain elevation if applicable A ft. <br /> General comments <br /> and recommendations: <br /> El Boring <br /> 1 Boring# <br /> 91 Pit Ground surface elev. !!✓✓ 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 I *Eff#2 <br /> �-� �6 -4& <br /> -2] Boring# Boring <br /> Pit Ground surface elev. ft. Depth to limiting factor in. <br /> Soil Application Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft <br /> in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. *Eff#1 *Eff#2 <br /> °7 <br /> 4, <br /> 7 <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) /S ignature CST Number <br /> Wade Rulfsholm fOz - ., 227691 <br /> Address Date Evaluation Conducted Telephone Number <br /> PO Box 514,Siren,W154872 C (715)349-7286 <br /> SBD-8330(R07/13) <br />