HomeMy WebLinkAbout008-1096-10-000 (2)Wisconsin Department of Industry, 3Labor and Human Relations SOIL AND SITE EVALUATION Page _ of
Division of Safety and Buildings in accordance W `'IOR83.09, WiS ,
n 7 v county
]� n Attach complete site plan on paper not less than 8 112 x 11 inches in siz Plgn must F F V �i ty T T exdo I,
Include, but not limited to: vertical and horizontal reference point (BM), rr c((on and `C ! `J /� X
percent slope, scale or dimensions, north arrow, and location and dista r`Zp neayf,froad. , reel I.D. if
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APPLICANT INFORMATION - please print all informatign::` 'ol,NTY Reviewed y Date
Personal information you Provide may be used for secondary purposes (Privacy Law, 4 7 94. ,11 Pm iNG OFFf
Property Owner • _, � r 90 fr1 J
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Property Owner's Mailing Address Lot # Block# Subd. Name or CSM#
n ry
233 7 eejE L'ti' S
City State Zip Code Phone Number
s— Nearest Road r/ u
tc�oo�l it/E Cv�. Syo2B c�8 f�7G D�,ty� 0Vi' ��� Town --Ty 913
New Construction Use: esidential / Number of bedrooms J Addition to existing building
❑ Replacement ❑ Public or commercial - Describe:
yob
Code derived daily flow gpd Recommended design loading rate bed, gpd/ft2_Z�/erench, gpd/ft2
Absorption area required 4M bed, ttz_!�0_21 trench, ft2 Maximum design loading rate bed, d/fl2 g g _tom gp l trench, gpd/tt2
Recommended infiltration surface elevation(s) tt (as referred to site plan benchmark)
Additional design/site considerations &4 15 %�%�Z7 7di2 �lyu vp SyS'7`��f7S
Parent material IDES 0e E G fE Flood plain elevation, if applicable ft
S = Suitable for system Conventiioonaall Mound In -Ground PPress�61 AT -Grade System in Fill Holding Tank
U = Unsuitable for system ❑ S i� U ❑ S I'J U ❑ S L�1 U ❑ S U ❑ g U ❑ S IJ u
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Boring #
a
Ground
el ev.
Depth to
Ilmiting
factor
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Boring #
i
Ground
elev.
Depth to
limiting
factor
40 In,
Horizon
Depth
in.
Dominant Color
Munsell
Mottles
Qu. Sz. Cont. Color
Texture
Structure
Gr. Sz. Sh.
Consistence
Boundary
Roots
GP01ft2
Bed , Trenc
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Remarks:
CST Name (Please Print) Signature Telephone No.
�a$�ipr Zf�/?icG�T 7!S- 396 • 91,65
Address Date CST Number j
06f - L5- 2-1-4e375
Private Sewage Consultants
655 O'Neil Rd,
Hudson, Wis. 54016
5elvv 416�
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PROPERTY OWNER
PARCEL I.D.#
Boring #
Mflt
Ground
alev.
--n.
Depth to
limiting
factor
—In.
sss.
Boring it
k'Al-ils SOIL DESCRIPTION REPORT
Z 3
Page _ of
Horizon
Depth
In.
Dominant Color
Munsell
Mottles
Qu. Sz. Cont. Color
Texture
Structure
Gr. Sz. Sh.
Consistence
Boundary
Roots
2
Bed Trench
o
loYR
/7
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s
z f
Z 3
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Remarks:
Ground
elev.
n.
Depth to
limiting
factor
In.
Remarks:
Boring #
V -1
Ground
elev.
n.
Depth to
limiting
factor
In.
Boring #
Ground
elev.
n.
r]om�r4c
Depth to 1�
limiting
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�in. Remarks:
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