HomeMy WebLinkAbout002-1024-10-000 (2)
Wisconsin Department of Commerce SOIL AND SITE EVALUATION
Division of Safety and Buildings Page of -91
Bureau of Integrated Services in r an`e`r~(+th s. ILHR 83.09, Wis. Adm. Code
Attach complete site plan on paper not less tha 11 I'xy11 inch*jn size. "ion >pust County
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include, but not limited to: vertical and horizo Werenc4PV1pj(Wr,,directioh and
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percent slope, scale or dimensions, north arr w, t1d location aritf'di§t6ce to nearest road. Parcel I.D. #
APPLICANT INFORMATION - P/e ' intallgpfi>(rq ltlet~ R iewed by Date
Personal information you provide may be used for setorr&i purposiW4WN4V Law, s. 1%" (m)). / / tl
Property Owner ' pioperty Location
` Govt. Lot r 1/4 1/4,S T, N,R 'JommW
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t- J Lot # Block# Subd. Name or CSM#
Property Owner's Mailing Address D
City State Zip Code Phone Number ❑ City ❑ Village Town Nearest Road
JP 14 8 1 k., ' (21_5Vd_4'=,7?13 1.d 10 ve.,
7Aditlon to exi bui m v
New Construction Use: ❑ Residential / Number of bedrooms g
❑ Replacement ❑ Public or commercial - Describe: - -7-
Code derived daily flow J gpd Recommended design loading rate bed, gpd/ft2LAA-trench, gpd/ft2
Absorption area required bed, ft2 trench, ft2 Maximum design loading rate bed, gpd/ft2_&~trench, gpd/ft2
Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark)
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IIV6)IV it- Additional design/site considerations ,,ii
a ft
Parent material GfJ - d 44 L Flood plain elevation, if applicable Alh
S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank
U = Unsuitable for system ❑ S [X U ❑ S EK U ❑ S ®U ❑ S 2q U ❑ S ® U ❑ S (,1 U
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench
1 / o- s A4 56 13s V A4 3"
-146 AO 2, C hi/r O'2 G S ! v r~
Ground b- b ? lVI F P f4l
A .5-6 A A Ac aaelev Sits A~-e
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Depth to
limiting
fac or
in.
Remarks: ReR/M4s*
Boring #
Ground
elev.
tt. ,
Depth to
limiting
factor
in. Remarks:
CST Name (Please Print) Sign re Telephone No.
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Address Date CST Number
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