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Wisconsin Department of Safety and Professional Services <br /> Division of Industry Services C5 1 a0 -5 Z <br /> SOIL EVALUATION REPORT Page of <br /> in accordance with SPS 383,Wis. Adm. Code 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 0/;Z a ya /,".02 5J <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. a" 05— 0Q$$ /0e) <br /> Please print all information. le ed by. Date <br /> Personal information you provide may be used for secondary purposes(Privacy Law,S.15.04(1)(m)). 5/'/2°241 <br /> Property Owner Property Location <br /> 2 f K e GJ e /53, Govt.Lot 1/4 1/4 S 5T yG N R/ E(or)W <br /> Property Owner's Mailing Address Lot# Block# Sabd-Name or CSM# <br /> / 33 b ft://55.3- .,f{- ) . - Is m Y I/Y'7-. <br /> City , Stefe Zip C6de Phone Number Oily T 0Village ,Town Nearest Road 277/, <br /> 1.141(e v, /e In,I) I;5--- <br /> 05Y1 ( ) :�/1 .I<s R: <br /> 41 ✓oma4,, <br /> nNew Construction Use$2! -esidential/Number of bedrooms 3 Code derived design flow rate 5'"—G2 GPD <br /> g -eplacement � a Public or commercial-Describe: —� <br /> 'arent material (:T`/4G;AI- ()r) 'l" Flood Plain elevation if applicable ft. <br /> General comments <br /> and recommendations: <br /> ril Boring# i Boring <br /> Pit Ground surface elev. C/1 3 ft. Depth to limiting factor �1 in. <br /> Soil Application Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/flz <br /> in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. *Eff#1 *Eff#2 <br /> 1 0_41 7.511 '3/. 15 - J7 /6 <br /> 3 17 7� 7,51014. — J A , T f, <br /> W <br /> riiBoring# LI Boring <br /> �/I 1 Pit Ground surface elev. ! ,, ft. Depth to limiting factor >7/ in. <br /> Soil Application Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/f12 <br /> in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. *Eff#1 *Eff#2 <br /> CI—5� 7r3-7/19 /. ii5le. yri Li{._ S .7 /4 <br /> 2 -- -- , ,eY/,, — /5 ',12.sig z :.), - -14—e-CI, C <br /> 12 23TY' 75`PAYZ --- 0.5 5 `77/ --- 17 <br /> h <br /> *Effluent#1 =BOD,>30<220 mg/L and TSS>30<150 mg/L *Effluent#2=BOD5<30 mg/L and TSS<30 mg/L <br /> CST Name (Please Print) )Signal re CST Number <br /> Wade Rufsholm (1/(1/44"---4 ---- 227691 <br /> Address Date Evaluation Conducted Telephone Number <br /> PO Box 514,Siren,WI 548726 (715)349-7286 <br /> SBD-8330(R07/13) <br />