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`rvis�ept.of Safety and rofessiolSemi9esz018 OIL EVALUATION RE RT Page 1 of 3
Division of Safety and Bu Idings IV r it QZ Z 7tk
in accordance SPS 385,Wis. Adm. Code V
St Crux County County J C I, C 1�0\X
Attach complete site pl n ,rro I A (a x 1 inches in size.Plan must
include,but not limited . point(BM),direction and Parcel I.D.
percent slope,scale or dimensions,north arrow,and location and distance to nearest road. -30 - 2 07 0 - 2.0- I b 0
Please print all information. Revi,red by Date
Personal information you provide may be used for secondary purposes(Privacy Law,s. 15.04(1)(m)). 0611 / It z G-
Property Owner Property Location u�
MARK DRul I- N Govt.Lot NW 1/41JE 1/4 S36T 3p N RZ0 E(or®
Property Owner's Mailing Address Lot# Block# Subd.Name or CSM#
1 2.8 .1 2.7 *r ST- 2 t csrn vow G P I Scl o
City State Zip Code Phone Number ❑City ❑VBlage ®Town Nearest Road
HLty k.) 1 Lllr1 .W0161 ( ) ST SOS EP1-► 1 27 " ST
IN New Construction Use:Ill( Residential/Number of bedrooms 3 Code derived design flow rate 1-I.50 GPD
❑Replacement 0 Public or commercial-Describe:
(
Parent material i was), Flood Plain elevation if applicable Zo11L x ft.
General comments au f� Ai_O r iQ
and recommendations:
�`�
I Boring# 0 Boring C p
• Q.�Pit Ground surface elev. /`i.. 5 ft Depth to limiting factor 78 if in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure consistence Boundary Roots GPD/ft 2
in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 'Eff#2
I 0 tO /0`I12 3/Z 5I Z m.b( MI C5 2 M •( /.0
2. Ib-8'4 /oyl? yly _ S orns1 MI - P 7 1, 6
2., Boring# ❑ Boring /
Pit Ground surface elev. 9 7.G 5 ft. Depth to limiting factor 7 S 7 in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft '
in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 'Eff#2
I o•4 leyR312- - SI 21rsd< rs,M CS 2r•., . G 1.0
Z 9-S7 la yr y/y — S orrscA M, I - . 7 I , 6
•
. /
•Effluent#1 =BOD s>30<220 mg&L and TSS>30 <150 •••1 'N E •-•lb—. '•D__,<30 mg/L and TSS <30 mgll
CST Name(Please Print) Signature CST Number
Cxt- SP4 ne l A , ) e2 2346 •
AddresS Date Evaluation Conducted Telephone Number
1ZSN;c.lee( ks+ OSc. coLP , w_T- S'i0)- 0 6- 22- Ig 715-4NO-Sl(lb
SBD-8330(RI I/I I)
r •
Property Owner (NS\. )R U C N E R Parcel ID#3 O •2 U 7 b - 2 0 - ID o Page 2. of •B
3 Boring# 0 Boring 11'' A
MX pit Ground surface elev. 9.L.1,`f 5 ft. Depth to limiting factor 7 a 8 in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft '
in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. •Eff#1 ''Eff#2
I 0 -IN /0y23/2 ` 5I_ 2msbK yy'i CS 2 LA . (, I, )
2 iq-88 /o y12y/y — S , orn 1 M\ — . 1 1.
Boring# ❑ Boring
❑ Pit Ground surface elev. in. r
(� ("� /`C� Soil Application Rate
Horizon Depth Dominant Color Redox Desi 1 • t ary Roots GPD/ft '
in. Munsell Qu.Sz. Con •Eff#1 'Eff#2
- f . IL
t I j i i j I Vt."---:0 ‘)
' S S0 ' , (�
. d) \13\
‘ k 01) .
, (I 'Li ,,IJA
❑ Boring U
Ong# Ground surface elev. �
❑ Pit — \1
Soil Application Rate
Horizon Depth Dominant Color Redox Descri ._._ .......uio ..,onsistence Boundary Roots GPD/ft '
in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. •Eff#1 *Eff#2
'Effluent#1 =BOD 5>30<220 mg/L and TSS>30 <150 mg/L 'Effluent#2=BOD 5<30 mg/L and TSS <30 mg1L
The Dept. of Safety and Professional Services is an equal opportunity service provider and employer. If you need assistance to
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5BD-8330(RI I I It
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