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.Wisconsin Department of Safety and Professional Services R I G I N A L <br /> Division of Industry Services <br /> SOIL EVALUATION REPOR Pai .3 <br /> m accordance with SPS 383.Wes. Adm. Code L91-1i i <br /> Attach complete site plan on papdr not less than 8 1/2 x 11 inches in size.Plan must County BURNE'17 <br /> include,but not limited to:vemial'and horizontal mferonce Pont(SM),direction and Parcel TD, 07 Cla0 a YD /6 /6s <br /> percent slope.scale or dimensions,north arrow,and located and distance to nearest road. T s O-i 000 <br /> Please print all information. Reviewed by Data <br /> Personal Information you provide may be used for secondary purposes(Privacy Law.a.15.ea f)(m)). <br /> 9fan 1015 <br /> Property Owner / / Property Located <br /> 1PA KAo Govl.Lot 1/4 114 S N R Or® <br /> Property er's Maili MMdr # Sue Lot q Block bli or GSMIf <br /> �8� /f1 /Y14 �e fir. — A`&i )6�4l Ln�e <br /> City r State Lp Code Phone Number ity F]V,11.ge Town Nearest Road M/ <br /> �� /q�i� 7✓• SS3Y ((s] i3-7Y-1763 p h4T/ire o �o �c� <br /> ®,New Constuctson Usem ResidenhalI Number of bedrooms cr_ Cade derived design now rate GPD <br /> n Replacement /� !n-� Public or mmerfeal-4escnbe: i--- <br /> Parentmaterial IIT/fa-C7Jg'� G)/`J— Flood Plain elevation if applicable ft. <br /> General comments <br /> andrecommendatieds: St'SEe»'t b'Le.12t�rort ; 9$.83 60 99.00 1� <br /> A(Oinld dS 54' ' 1AE)JAt}6A { Mk41T0MEDy SOILS <br /> © <br /> Somali# ❑ Spring <br /> ® Pit Ground sudaceelev. 99.o fl, Depth to limiting factor in. <br /> s—a Application Rata <br /> Horizon Depth Dominant Color ' - Rei Descripteori Texture SWcture Consecence Boundary Roots GPD/H <br /> in. Munsell Ou,Sz. Cont.Calor Ge Sz.Sh. 'ER#i 'EH#2 <br /> 0-6 ,5 �/ /'S / J6K /Fr c5 3�Cv ' -7 1,.0 <br /> /S //ns 4- dPr 5 3 4 , 7 , G <br /> 7Y 7 $' 0 5 el — 21 7 A L <br /> ® Bonn,# ®"Boring <br /> E] pit Ground surface elev. &, 7 fl. Depth to limiting factor -;� ,-Z in. <br /> Sal Application Rale <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM <br /> in. Munson Qu.Sz. Cont.Color Gr.Sz.Sh. 'ER#1 'ER#2 <br /> 0-5- 7-50 1 ,5 , '/ /,6 <br /> 2 070 7 Xy1W /5 - - <br /> �7,z YIy6 - ,7 /i <br /> 'Effluent#1 =BOD,>30<220 nrgi and TSS>30<150 rnA 'Effluent#2=SOL,<30 ani and TSS<30 M91 <br /> CST Nam (Please Print) Signature CST Number <br /> Wade Rufshu hn o-eG 227691 <br /> Address Date Evalui Conducted Telephone Number <br /> PO Box 514, Simn, WI 54872 11-17-11 (715)349-7286 <br /> 3MD-iJJJ0(KU7f)J) <br />