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HomeMy WebLinkAbout018-1086-03-000 Wisconsin Department of Industry, SOIL AND SITE EVALUATION / Z Labor and Human Relations - Page of Division of Safety and Buildings in accordance I U18 .0'g, WIS. Attach complete site plan on paper not less than 8 1/2 x 11 inches in ,`plan mCounty upt- include, but not limited to: vertical and horizontal reference point (B direction anti y I~ percent slope, scale or dimensions, north arrow, and location and di tanoe to nearest road. Parcel I.P. # O 04 ' ~d yi~Lffa • APPLICANT INFORMATION - Please print all lnformwon. Revie d Date Personal information you provide maybe used for secondary purposes (Privacy L @ w,s . t 5. f1) rF"rr,r Property dwner H~ U M (3 l eD /.Ally 0 C b Property Location 7 ~N'A~ ~L 134 1 ((0 /V t3bv(. (.of t f " 1/4 1/4,S G1; TZ N,R / E (or) W Property Owner's Mailing Address Lot # ock# Subd. Name or CSM# 332- hiuNtsoTA ST. EAST Iyoq .3 +&f.jVA,#AD 99/+&t' / Z. City state Zip Code Phone Number Nearest Road k> Y. 15r. UL MA3. JTS/O) (&5/ )222 •-555,5 ❑ City ❑ village L7 Town q,~ ((1b ['Flew Construction Use: L•~rsesidential / Number of bedrooms 3 Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow 43*49 gpd Recommended design loading rate bed, gpd/ft2 trench, gpd/ft2 Absorption area required bed, ft2 trench, ft 2 Maximum design loading rate bed, gpd/ft2_ __trench, gpd/112 Recommended infiltration surface elevation(s) S 4 3 _ft (as referred to site plan benchmark) 1 43 Additional design/site considerations ~_ft Parent material 10ECS 60W DENSE- 7/;//,% Flood plain elevation, if applicable N,,/ S = Suitable for system Conventional ~Moun ' In-Ground Pressure AT-Grade , / System in Fill Holding Tank U = unsuitable for system ❑ s LEI ual GRIS ❑ u ❑ S L~U ❑ s L~'U ❑ S L ❑ S SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench -,Aq io y 313 - $/G Z SbG .wl►~' CS - .s . Cn ` CS • Z , ' 3 Ground e, 0 /Q Y / L lS,✓ 4#q Al elev *ft. to ege 31V 2X N oTs 54Z N iN Depth to limiting factor 267- in. Remarks: Boring # p •/i /V Xif 3 L 17cs6K /N77'1:,e W / IC- • - S• V G S• !o y N1 S - JL 1 fly hA;~_ 4" Ground . ; eleev .Q ft. & Depth to limiting factor 70 in. Remarks: A •f. CST Name (Please Print) R®pLeRT- 1~IL~R~G~I'T' Signature Telephone No. Address Date CST Number Ultldcht & Associates ttants 2.4 3 -7 5 MY- 655 O'Neil Rd. Hudson, Wis• 54016 1 N U~ 81 ~O L AaL) SOIL DESCRIPTION REPORT PROPERTY OWNER Page of 2 //AAlMOA D 41A S Ogfl PARCEL LD.N GO ~ 3 G~pjft2 Boring # Horizon Depth Dominant Color Mottles Structure Texture Consistence Boundary Roots 1 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench 3 < ~t •s Ground 5, AV 1 `D i I/ f 64 .7 4r elev. Depth to • S j limiting 2 , factor in. Remarks: Boring # Ground elev. Depth to limiting factor in. Remarks: 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. ft. Depth to limiting factor in. Remarks: SBDW-8330 (R. 08/95) I L Cc>~s T Go 7- ~ ~ I_ h d~ w r.r a ba p v~ ul ~ `Q Z c ~ ~ ~~s T Lo T ~ -n u a~ ~ N Q p n~ lA, O 1` 1 7 M V Q