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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 LD. C 7 0,3o2 v2 41/ /'6 027 / <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. 0, 0 c'L7 e,/9 pc.)jJ <br /> Please print all innffoovnnattiorn. Reviewed by Date <br /> Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). <br /> 9 Property Owner Property Location <br /> El- <br /> ,, <br /> I A)n-/) 6V/,j Govt.Lot S 4: 1/4/..,j-1/4 Sz.7 T y/ N R/O E(or)W <br /> Property Owner's Mailing Addre sLot# Block# SobC'Name or CSM# <br /> y 4.7/bec4 /- �� - i/ 1,0 7e) <br /> !City State Zip Code Phone Number 6City 0 Village U.Town Nearest Road 7/6 d <br /> /1)e''> 6'1'2-- Vn id I 5-5- ..2,)) I ( ) ..J2W S S S I/7/V/ 4rr <br /> ,D New Construction Use ki Residential/Number of bedrooms -3 Code derived design flow rate '�/5 G) GPD <br /> Replacement • Public or commercial-Describe: <br /> Parent material G/gC i d//14`f' Flood Plain elevation if applicable M-'A- ft. <br /> General comments <br /> I and recommendations: <br /> l <br /> I <br /> i <br /> i <br /> a 'at Boring <br /> Boring# V ft7 <br /> Pit Ground surface elev. ' . Depth to limiting factor /2 in. <br /> Soil A..lication Rate <br /> Horizon Depth 1 Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fie <br /> in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. *Eff#1 "Eff#2 <br /> i J <br /> u 1O ' /5 G 7 / , <br /> s367YRVi. — /5 - , 7 /, <br /> 3 133`7? 5 Y . _ — , 7 1, <br /> L. 4 mil <br /> IIIIIge <br /> 1 , <br /> 1 Boring# DI <br /> Boring <br /> EI 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/ffl <br /> in. 1 Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. "Eff#1 "Eff#2 <br /> 1 <br /> 1 iilMr . <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) Signature CST Number <br /> Wade Rufsholtta r 227691 <br /> Address Date Evaluation Conducted Telephone Number <br /> PO O Box 514,Siren,WI 54872 (715)349-7286 <br /> SBD-8330(807/13) <br />