HomeMy WebLinkAbout184-1001-40-000Wisconsin Department of Commerce SOIL AND SITE EVALUATION
Divlosi6n of Safety and Buildings Page of
Bureau of Integrated Services in accordance with S. ILHR 83.09, Wis. Adm. Code
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County
include, but not limited to: vertical and horizontal reference point (BM), direction and ,C G
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. parce .D. #
I f Y-Ln (- a -00.r,'
APPLICANT INFORMATION - Please print all information. Reviewed by Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)).
Property Owner Property Location
t Govt. Lot �,! 114 ��-'1/4,S .3 T -'b ,N,R js E (or) W
C2 . S . ,'
Property Own@Ys Mailing Address Lot # Block# Subd. Name or CSM#
City State Zip Code Phone Number ® City 'Village H Town Nearest A
(���) s�3S" ��,�., �'-��., CADY 1 ,,_s, A
ew Construction Use:
0 Residential / Number of bedrooms
'7 Addition to existing building
❑ Replacement
❑ Public or commercial - Describe:
Code derived daily flow
god Recommended design loading rate
bed, gpd/ft2 '-
trench, gpd/ft2
Absorption area required �
bed, ft2 — trench, ft
Maximum design loading rate r
bed, gpd/ft2 �trench,
gpd/ft2
Recommended infiltration surface elevation(s)
ft (as referred to site plan benchmark)
i
Additional desigrVsite considerations
Parent material �` Z
/
�' +'4- �/
Flood plain elevation, if applicable
ft
S = Suitable for system
Conventi�onal�
Mound
�
In -Ground Pressure
❑ au
AT -Grade ,/_
❑ S C] U
System in Fill
❑ S 0-t_
Holding Tank
❑ S
U = Unsuitable for system
❑ S �1 U
❑ S
S
Qr%11 n9Qr`PIPTlnFJ RFPnRT
Boring #
Ground
elev.
r ft.
Depth to
limiting
factor
J(--in.
Ground
elev.
ft.
Depth to
limiting
factor
-�__in.
CST Na
Horizon
Depth
in.
Dominant Color
Munsell
Mottles
Qu. Sz. Cont. Color
Texture
Structure
Gr. Sz. Sh.
Consistence
Boundary
Roots
GPD/fit
Bed Trench
�
p73
Remarks: s c. x` i S t-I r� 3 G
r
`fK
3 !t �
-C 3p
s 7R d Cv" �h"-
5
Remarks:
(Please Pri t)
Address
7;70
Signature
'telephone No.
7�f
Date CST Number
a % V
PROPERTY OWNER SOIL DESCRIPTION REPORT Page L/
.-7-
PARCEL I.D.#
Boring #
L
Ground
elev.
Depth to
limiting
factor
�in.
Boring #
Ground
elev,
Depth to
limiting
factor
� in.
Boring #
Ground
elev.
-.�—tt-
Depth to
limiting
fa
ct rin.
Boring #
ci
Ground
elev.
Depth to
limiting
I
2"!ain.
Horizon
Depth
in.
Dominant Color
Munsell
MOMBS
Qu. Sz. Cont. Color
Texture
Structure
Gr. Sz. Sh.
Consistence
Boundary
Roots
G�p/f,2
Bed Trench
10
71- —C
7 2
/'/J
Remarks: 7 'r-,
,
F-
Remarks:
Horizon
Depth
in,
Dominant Color
Munsell
Mottles
Qu. Sz. Cont. Color
Texture
Structure
Gr. Sz. Sh.
Consistence
Boundary
Roots
GPD/fF
Bed Trench
At
4--:1
Ij
Remarks: <
7
C
4LI-
Remarks:
SBD-8330 (R. 07/96)
PROP . �RTY OWNER — L)JIILZ 14-S V SOIL DESCRIPTION REPORT
'PARCEL 1. D.#
Page Of 4
Boring #
Ground
elev.
n.
Depth to
limiting
fact
7in.
Boring #
.X
Ground
elev.
Depth to
limMng
faor
In.
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
in.
Boring #
Ground
eiev.
Depth to
limiting
factor
in,
Horizon
Depth
in.
Dominant Color
Munsell
Mottles
du. Sz. Cunt. Color
Texture
Structure
Gr. Sz. Sh
Consistence
Boundary
Roots
Q�D/A'
Bed Trench
'lip
f -UE-
------------
Remarks:
C
we
L)
A------
Remarks:
Horizon
Depth
In.
Dominant Color
Munsell
Mottles
Du. Sz. Cont, Color I
Texture
structure
Gr. Sz. Sh,
Consistence
Boundary
Roots
gPD
Bed Trench
2
V1,
J
Remarks:
Remarks:
SBD-8330 (R. 07196)
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