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Wisconsin Department of Industry, SOIL AND SITE EVALUATION / 2
Labor and Human Relations Page of
Division of Safety and Buildings in accordance with s. fLHR 831.091, Wis.
'
Attach complete site plan on paper not less than S 1/2 x 11 inches in zee flan mint, Cd'ty •
. 57C•oe0l•k
include, but not limited to: vertical and horizontal reference point (B *ction ann.-` it,7,r,
percent slope, scale or dimensions, north arrow, and location and d' tande to crest road4 j J
Parcel" D. # 0
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APPLICANT INFORMATION - Please print all in
for a71~ . ~t ~Revi d by Date
Personal information you provide may be used for secondary purposes
(Privacy idLDAI1'!, ar - S~
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Property Owner JiV N Q l RD I-AA3 p< CI rw .Property L ti J n Q
V" ~L'A) ~7T4 1 1D/v 43 _ h) 1/4 A14 1/4,S ZV T / N R (or) W
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Property Owner's Mailing Address Lo -7 # Subd. Name or CSM#
332. h i uatsoTA ST GAS T I yo q y ~FM.tiowD 0-1f& X
City State Zip Code Phone Number Nearest Road k! Y. / 72-
ST• UL MN.. 5S/o ((05/ )222 •SSSS ❑ pity El Village I Town l(ob
0 (Jew Construction Use: 9 esidential / Number of bedrooms •3 Addition to existing building
❑ Replacement ❑ Public or commercial - Describe:
Code derived daily flow ff a gpd Recommended design loading rate bed, gpd/ft2 trench, gpd/ft2
Absorption area required 315L"_bed, ft2 3757 trench, ft2 Maximum design loading rate • bed, gpd/ftC:-:$F::trench, gpd/ft2
Recommended infiltration surface elevation(s) • Aa ~a 3 ft (as referred to site plan benchmark)
Additional design/site considerations
Parent material 44FIFS O&V QFiV$E- T/ /If Flood plain elevation, if applicable ~,s¢ _ft
S = Suitable for system Conventional MM d In-Ground Pressure AT-Grade / System in Fill Holding Tank
U = Unsuitable for system ❑ S L~f U rJ 5 ❑ U El S E ❑ S ✓U U ❑ S U ❑ S
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
•13 10 yg 2f'3 - f- / fAe Sk w .Y s
3 •i ioy1f 3 Sim 2fs k
Ground 7. /pYle /AN /yM v c/ • -l • *
elev. 2
Mohr of /YSk Ael
Depth to
limiting
factor
lI Remarks:
Boring # / a'~ ~a!l/~ ~/3 L /~'Sbe /Iw~ie w / ~ ' ~ ; •.S
Z • 19 lo /t - if c
w.._ . L /D G 2. f shk, 14 C $ '
Ground /0 S. Q J S / ' a
elev. io ~Y~L /
Depth to
limiting
nfor
ia
3 n. Remarks:
CST Name (Please Print) Signature ' - 7~STelephone 8'
Address Date CST Number
Ulbricht & Associates /yls . 2•ft 3 7 5
Private Sewage con.1,16,A20
655 O'Neil Rd.
Hudson, Wis. 54016
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PROPERTY OWNER Nom 6 1 eLD I AaI) SOIL DESCRIPTION REPORT Page Z of 3
PARCEL I.D.# /,0 7- Z HAHHOAit7 4A k-5 S°gf)
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots 2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench
1001 V3 4 lfrhlt
•!S /oY 3 S/t. 12- f S ee Al Ground • l VA '11V 57 51- l fS' "
~r S... . {
elev. s• ~•syRs z ~
~~S if f/Z
~,e
mom
Depth to
limiting
factor
Remarks:
Boring #
Ground
elev.
ft. ,
Depth to
limiting
factor
_._in.
Remarks:
i
Horizon Depth Dominant Color Mottles Structure GPD/fe
Texture Consistence Boundary Roots
in'. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench
Boring #
Ground
elev.
_-ft.
Depth to
limiting
factor
in. Remarks:
Boring #
Ground
elev.
I
ft.
Depth to
limiting
factor
in. Remarks:
SBDW-8330 (R. 08195)
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