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Wisconsin Department of Safety and Professional Services <br /> Division of Industry Services C-51—20-194-i <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. Cr,"7 c.f.i..? -39 /V 14. <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. / 0 c/ 04fIp O/.2©00 <br /> Please print all information. Reviewed y Date <br /> Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). 1 /Z)-•-•T.z lj <br /> Properly Owner ( i Property Location "C.- <br /> ,..5-e,il,�J�- t�`j/`/5275/6A e CS er,J Govt.Lot SE 1/4Na-1/4 S/,Z T 3.s N R f E(or)W <br /> Property Owner's Mailing dressLot# Block# Subd.Name or CSM# <br /> /a <br /> City [ State Zip Code Phone Number laity Village IjTown Nearest Road /O i ..5 <br /> 1 Gr ititiT3 4 t., 1 I PfU I ( )m .V375 CVeCc if/ v e_r- 1 ilie -.9 ca Rd <br /> aNew Construction Use 011j Residential/Number of bedrooms .%L Code derived design flow rate ,3C3 C) GPD <br /> 0 Replacement / e Public or/commercial-Describe: <br /> Parent material L9' /9C,/- / C 1/ 7c7c Flood Plain elevation if applicable "l-/A ft. <br /> General comments <br /> and recommendations: <br /> i <br /> 1 <br /> / Boring# l Boring k <br /> jPit Ground surface elev. /q <br /> ' ft. Depth to limiting factor --3-::Z 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 /> / D'7 7 -7,P4 4. 5' //1231.4- "7/. 4-5- .0--cc, , 7 ' li 6 <br /> 7-5,2 7,5y° 4' _ //i ,z27.5.‘&_ , t i <br /> 7i - 3/s (c S, , y <br /> 8 <br /> i <br /> El i 071 Boring# ., Boring <br /> Pit Ground surface elev. Yr ft. Depth to limiting factor ->37 in. <br /> 1 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 /> p 7 73y /S /ten die. � c 5 .7 0 ,7 i1 C <br /> 02 7-37 7 gg°% — /i /4'514. - -(/-- — )7,4 eo ,s q <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) Signature / / CST Number <br /> Wade Rufsholm ala- 4--- 227691 <br /> Address Date Evaluation Conducted Telephone Number <br /> PO Box 514,Siren,WI 54872 (715)349-7286 <br /> /7 av <br /> SBD-8330(R07/13) <br />