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Wiscon~inDepartment o~ ~ OIL EVALUATION REPORT Page ( of~
DlVision o? Safety and Bu200
in accordance th Com m 85, Wis. Adm. Code
OIX cou,N7 County Attach complete site pl NGEM~ I > 1/2 x 11 inches in size. Plan must
include, but not limited to: vertical an erer ce point (BM), direction and Parcel I.D. 11-
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. OaL7-- 1 l a 1 - 1-1
M d Date
Please print all information. c
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). L22:;~ 1 '47 4-
Property Owner Property Location
F A Of- ~ d ess Govt. Lot S c,.,7 1 /4 1 /4 S jC T a o N R J~ E (or
Property Owner's Mailing Address Lot # Block # Subd. Name or CSM#
III3 I 6q 1-7 ari't;A go
City tate Zip Code Phone Number ❑ City ❑ Village [K Town Nearest Road
IUJ k«~4~ we sy0~7 c-~is) au6-bQ~3 R►~~v"a 7T" S-f-.
New Construction Use: X Residential / Number of bedrooms Code derived design flow rate 4 5110 GPD
❑ Replacement ❑ Public or commercial - Describe:
Parent material a ~4 C i 4 1 T i I 1 I Flood Plain elevation if applicable ft.
General comments SV6 5 f- + 3 - S .I. 'fig ~t_U ,''Sr F:p r" 4L 0., t. i~%
and recommendations: rV1 1-3 T. I Cron. 2 7 ' ,
5~~ C d -?.a t aq.S. 4e. ol . T.'f 016.3Y'~
-r, 11,30') -T4 ( 9?. b
Boring # ❑ Boring
Pit Ground surface elev. 1(>3, ~O ft. Depth to limiting factor C1 d in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
I (09 104K3/a SL DP&P, dsa as aF .5 ,9
a 9-1a 10yp514 SL aFs8K ds Cw iC ,s .9
3 Ia-ao 10 qR 41q Sr-L 3WSISK d sV'i, CW )Q P ~ 4 .6
y 050•3q 7.51 yR y b S L a FSr3 8 s~ a iv 1: , s . 9
5 3q.-160 S yR y 1.. I Fsa dski
y ~o
F(~] Boring # I❑y Boring
tLl Pit Ground surface elev. 100, 60 ft. Depth to limiting factor 7S in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
l 4-`j I01R 31a L 01p&R 8ski Qs ar- ,5 t9
a 9 -30 7-548 41a M59 sl1 CI F ~ S A
3 a6--its I'Sq sl s Fs ds - , 5
* Effluent #1 = BOD5 > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L
CST Name (Please Print) Signature CST Number
1\-)o hn a -r s-~Af OZ12 as 4b
Address Date Evaluation Conducted Telephone Number
0~~6 Zeal S~' S+ac Prtk 've we 540 JD- Iq-ol --)1S-0-)y2-3S9Y
SBD-8330 (R07/00)
Io I
PropertyOwner f'Fa~'1' ISUilO<fs Parcel ID # Page C~ of
F3_1 Boring # ❑ Boring
Pit Ground surface elev. O/ .B •Z ft. Depth to limiting factor 100 in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
1 0-lO 104p 3 a SL ;jrt p, ds~ AS dF ,S ,9
a io-ly 10 4R 414 ESL amsak s1% CvJ 11: S
3 14-36 IMR y1t `aSL ).CS6k 6St\ A~ 1~F ►y
L4 36-roo 11411
SL ►FSQ
F Boring # ❑ Boring
Pit Ground surface elev. O! y.75 ft. Depth to limiting factor S in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
I 0-9 iOAR 34 - SL aFMZ sh as dF 15 ,9
a -a1 ~,5 kI 51 - SL OPSA aS ,J ,5 -9
3 a1-36 5 q14 - SL aFSQ as C\J 1„F .5 .9
36- a SyJZ41q SL )Fsa
Boring
❑ Boring # Ground surface elev. ft. Depth to limiting factor in.
❑ Pit
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
* Effluent #1 = BOD5 > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L
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