HomeMy WebLinkAbout184-1001-80-000Wsconsin Department of Industry, SOIL AND SITE EVALUATION REPORT
..c,bor and Human Reiattons
Division of Safety & Buldinas -a ,.,:0, ii u❑ 013 nr; %AA: Art.., r1. 4
Page N of ICJ
COUNTY
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, trait-•
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PARCE I.Q.
not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or !�
dimensioned, north arrow, and location and distance to nearest road.
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REV'IEWEQBY DATE
APPLICANT INFORMATION -PLEASE PRINT ALL INFORMATION
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PROPERTY OWNER:
PROP EXX iQ& N y
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PROPERTY OWNERS MAILING ADDRESS
LOT 4
BLOCK
ME OR CSM #
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CITY, STATE ZIP CODE PHONE NUMBER
❑CITY ®VILLAGE
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OWN
NEAREST ROAD
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ROAD
[x� New Constructton Use [Kj Residential / Number of bedrooms I J Addi#ign to existing building
[ j Replacement [ ) Public or commercial describe
Code derived daily flow `-i S0 gpd Recommended design loading rate "f bed, gpolft2 a • j trench, gpolft2
Absorption area required bed, ft2 31 S trench, ft2 Maximum design loading rate r' 'F� bed, gpolft2 p � � trench, gpolft2
Recommended infiltration surface elevation(s) at 1-6 • S It (as referred to site plan benchmark) T_lid, Nca"-5 0.fl r, L L
Additional design J site considerations TZQ_L 0U V PN\-T Mbutvp wI4k9 y'rZ& e14. -
Parent material Q)2sS Flood plain elevation, if applicable A ft
S = Suitable for system
U= Unsuitable fors stem
CONVENTIONAL
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IN -GROUND PRESSURE
N S ®U ❑ S RU
AT -GRADE
❑ S II U
SYSTEM IN FILL
❑ S LOU
HOLDING TANK
❑ S [RU
Boring #
4
Ground
elev.
ft
Depth to
limiting
factor
o"
Boring #
I
iul
Ground
elev.
_t6- 3 ft.
Depth to
limiting
factor
lots
Z � SOIL DESCRIPTION REPORT
Horizon
Depth
in.
Dominant Color
Munsell
mottles
Qu. Sz. Cont- Color
Texture
I Structure
Gr. Sz. Sh.
Consistence
BardEry
Roots
GPD/ft
Bed Trench
1
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Remarks:
ST Name: —Please Prat Phone:
Arthur L. Wegerer 715-425-0,165„-„
ergerer Soil Testing & Design Service-P.O. Box 74 River Falls,WI 54022
signature: 9 Date: CST Number:
M00576
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PROPERTYOWNER sPlz1nr6 VJPrU SOIL DESCRIPTION REPORT
PARCEL I.D. #
Ground
elev.
(iq,() It.
Depth to
limiting
fac`to¢rr
kv
Boring #
Lill
+:
Ground
elev.
ft.
Depth to
limiting
factor
Boring #
i
Ground
elev.
it.
Depth to
limiting
factor
Boring #
w09.\Vtik
Ground
elev.
it.
Depth to
limiting
factor
Page ? of 3
Horizon
Depth
in.
Dominant Color
Munsell
Mottles
Qu. Sz. Cont. Color
Texture
Structure
Gr. Sz. Sh.
Consistence
Boundary
Roots
GPD/ft
Bed Trerrh
o-q
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Sit
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emarks:
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PLOT PLAN
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CST Signature Date Signed
(7I5 ) 475-0-165 M00576
Telephone No. CST #