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Wis.Dept.of Safety and Professional Services SOIL EVALUATION REPORT <br /> Division of Safety and Buildings Page_of <br /> in accordance with SPS 385,Wis. Adm. Code <br /> Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County BURNET— T— <br /> include,but not limited to:vertical and horizontal reference point(BM),direction and <br /> percent slope,scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. 7 <br /> 3 v <br /> Please print all information. Reviewvu Date <br /> Personal information you provide may be used for secondary purposes(Privacy Law,s. 15.04(1)(m)). <br /> Property Ow er b <br /> Property Location <br /> ZEN- ToAx)sn"i Govt. Lot 1/4 1/4 S y Ty` N R (o <br /> Property Owner's Mailing Address Lot# Block# Subd.Name <br /> `� // 5 -f /,J — ' 51 ::::o,B�<•�s Acres <br /> City State Zip Code Phone Number ity Village own Nearest Road <br /> //u) er �� 5 sob c s ) y39-Y977 <br /> New Construction UseF] Residential/Number of bedrooms Code derived design flow rate <br /> GPD <br /> Replacement ❑ /Public or r,Ommer ial-Describe: <br /> Parent material �/`rC/�q ( �� Flood Plain elevation if applicable <br /> ft. <br /> General comments <br /> and recommendations: <br /> �r u`f ou.5 �? <br /> [j] Boring# Boring <br /> 9 Pit Ground surface elev. ft. Depth to limiting factor in. <br /> Soil Application Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft t <br /> in. Munsell Qu. Sz. Cont.Color Gr.Sz. Sh. ff#1 ff#2 <br /> 11% o " , 7 �G <br /> `/� 7s % j S 7 <br /> 3 947-� ,E'Y s <br /> ❑ 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 3onsistence Boundary Roots GPD/ft <br /> in. Munsell Qu.Sz. Cont.Color Gr. Sz.Sh. Eff#1 * ff#2 <br /> *Effluent#1 =BOD 5>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) Signatures CST Number <br /> WADE RUFSHOLM �a� - C ��� 227691 <br /> Address Date Evaluation Conducted Telephone Number <br />