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Home My WebLink About020-1057-60-200 (2) wiscdnsin Department of Industry, SOIL AND SITE EVALUATION Labor and Human Relations 2 Divlslon of Safety and Buildings in accordance with s. ILHR 83.09, Wis. Page / of .a 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 7 / G~0 / percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. # APPLICANT INFORMATION - Please print all information. 0 Z~ no ad ^ Dale Personal Informatlon you provide may be used for secondary purposes (Privacy Lew, s. 15.14 (1) (m)). Property Owner Property Location C~IL Govt. Lot ,s,jc- 1/4 Nj6 i/4,s Z? • T Zy N,R E (or W Property Owner's Malling Address Lot~l Block# Subd. Name or CSM ~ 4 s~ 67 ~y. /Z y J I - / ?Z 3L-2 Cl State Zip Code Phone Number Ul7,fO,ff Nearest Road 4>/. SYo ~ ~i5 ~ 3~(0 • y1il~ ❑ city vl tags ff"Town hl 9 New Construction Use: Residential / Number of bedrooms Addition to existing building ❑ Replacement 41-6[1 Public or commercial -Describe: - OF Code derived dally flow 40490 gpd Recommended design loading rate '7 bed g 9N trench, 9Pd/ti2 Absorption area required'- bed, ft2 ~ ~ trench, ft2 c- Maximum design loading rate _ 7 bed, gpd/itz~trench, gpd/ft2 Recommended infiltration surface elevation(s) 3 It (as referred to site plan benchmark) Additional design/site constd A = ~ticf~A~</ Lp.vW1QG Parent material g s CS SB S .¢S OT /G7 Flood plain elevation; If applicable S = Suitable for system Conve tional Mound In-Group Pressure AT-G ade System in Fill Holding Tank U Unsuitable for system [as U 5 El U li?s ❑ U ❑ U [as0 U ❑ S SOIL DESCRIPTION REPORT Boling # Horizon Depth Dominant Color Mottles Structure In. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots G D/ft~ r _ Bed Trench to /6 7-3 S!L ~S/✓ Ground 3 /o SiL .54e nyl AI e s ; . elev. - ~o•(Z~ft. L //M flip S C51 • ? .8 Depth to J - • 7 ' limiting factor , > T D In. Remarks: Boring # 2 2 0 - S/G Zf S ie CS /IG . S; . 3 SL ~n w~ CS . Y ~.,5 Grou S 74 7 eft. o L S - ,g ZO Depth to limiting factor In. Remarks: CST Name (Please Print) Signature Telephone N ~'oC3 T- Z//6,Pi~ T 3 ~ • g 5 Address Date CST Number .,1,2q- t -7 csr-v -i'IFL. Private Sewage Consultants 655 O'Neil Rd. Hudson, Wis. 54016 ThIS test site AP tic Syste~- for a conv~ntional sip zA, o ~ ~ o So ~ o ~ N - 11 c ~ INI ~ ~ 0 1 rib ~1 ~ 1h w N Q - 4y ~ o0too; I ~ aa~o Q, c a a 0 -lb W s9gDgh *partment of Industry, SOIL AND SITE EVALUATION Page / of , ;,•3 Labor and Human Relations Wis. Division of Safety and Buildings in accordance with s. 1I-HR 83.09, Attach complete site plan on paper not less than 81/2 x 11 Inches in size. Plan must County JC. Include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. parcel I.D. APPLICANT INFORMATION - Please print all Information. r eviewed by Date Personal Information you provide may be used for secondary purposes (Privacy Law, a. 15.04 (1) (m)). Property Owner Property Location Govt. Lot /UG 1/4,S 22 T Zp N,R E (or W Property Owner's Mailing Address Lot R Block# Subd. Nam SM#C.Siy -7 17 CI State Zip Code Phone Number Nearest Road f~uID,SO-cl lv/. S yo t ~~5 ) 3~(v' 91~~ ❑ city via~a Q~Town ,1~~/. / 2- 03-New Construction Use: Residential / Number of bedrooms 3 + Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived dally flow gpd Recommended design loading rate bed, gpd/tt2 g trench, gpd/ft2 y GCJ ~ Absorption area required -bed, fie -731b trench, it2 Maximum design loading rate • 7 bed, gpd/f ' O trench, gpd/ft2 Recommended Infiltration surface elevation(s) •s'Ze- + 0 3 ft (as referred to site plan benchmark) s /~(SCt -1 9+e/ LO-v W Additional design/site consid 9 ~ Parent material SG5 SB S As. G ' Flood plain elevation, if applicable tt P ound In-Grou Pressure AT-9 ade System In Fill Holding Tank i S Suitable for system Conve tional M Qs ❑U MIS ❑U as ❑U ❑S I U Unsuitable for system L7 S ❑ U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2 In. Munsell Du. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench /"ICe s . Z' .3 y #,10 !d 7.-/,3 SIC,~5/✓ 40- CS , /vrL , z ; Ground 3 3 51z- 54e eS $ (r I- 0. (L n. O S O •7 g o Depth to limiting factor Remarks: t Boring # S/L ~fS~J ~ ~i~ 5 , Z . , 3 /0 ve 4W 1/& o'37 Ground D Wey. 1y• IT-% o S ;o Depth to limiting factor ; tn. Remarks: CST Name (Please Print) Signature Telephone N . boa T- Z!/brP/C~iT- 7/ S- 30(C, • ~C31 ~3S Address Date CST Number y 2 q- t csr~ zVpL ,Tit CL Private Sewage Consultants 655 O'Neil Rd. Hudson, Wis. 54016 • e APPRQIjet eon. "phis tes{ sit al septic *st fora convention copy s T l ,