Laserfiche WebLink
Wisconsin Department of Commerce SOIL AND SITE EVALUATION I <br /> Division of Safety and Buildings Page I�of 3 <br /> Bureau of Integrated Services in accordance with Comm 83.09, Ws. Adm. Code <br /> Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County <br /> include,but not limited to: vertical and horizontal reference point(BM),direction anduAir T7'percent slope,scale or dimensions,north arrow,and location and distance to nearest road. Parcel I.D.# <br /> 6a4--310 - ao - 2'110a <br /> APPLICANT INFORMATION- Please print all information. Reviewed by Date <br /> Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). / n <br /> Property Owner Property Location 4 oc <V SCJ <br /> AIQ WEA&JCA Govt.Lot N ,£ 1/4TE- 1/4,S oZ T'3 9 N,R /5/ (or)W <br /> Property Owner's Mailing Address Lot# Block# Subd.Name or CSM# <br /> ) 6- o A <br /> City State Zip Code Phone Number <br /> ❑ City ❑ Village D�Town Nearest Road <br /> EE New Construction Use: Residential/Number of bedrooms Addition to existing building <br /> ❑ Replacement ❑Public or commercial-Describe: <br /> Code derived daily flow o o gpd ¢"Recommended design loading rate 1_bed,gpd/ft2 . 8 trench,gpd/ft2 <br /> Absorption area required a� bed,n2 J'7J trench,n2 Maximum design loading rote __bed,gpd/ft2_he?__trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s) Qy n(as referred to site plan benchmark) <br /> Additional design/site considerations IESfi IY64 S t,6 A T l�onl —tat)) 11 12;C N T s NL;G HT <br /> Parent material K1,A C/P4 OR t FT Flood plain elevation,if applicable n <br /> S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank <br /> U = unsuitable for system �❑ U El S ❑ u ❑ s ❑ u ❑s ❑ u ❑ s ❑ u ❑s ❑ u <br /> SOIL DESCRIPTION REPORT <br /> Boring# Horizon Depth I Dominant Color Mottles Structure GPD/ft2 <br /> Texture Consistence Boundary Roots <br /> in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. Bed , Trench <br /> l 0-3 7,S — LS I Sb <br /> r <br /> elev.Ground a a / % — -Co.P <br /> Depth to <br /> limiting <br /> factor <br /> Remarks: <br /> Boring# <br /> -6Ah c i/ C S e7�i 7 <br /> — fs flab <br /> Ground <br /> elev. <br /> Depth to �`'`, <br /> limiting �I <br /> factor <br /> min. Remarks: <br /> CST Name (Please Print) Signatur Telephone No. <br /> iff7clf L J-c&/* ►Eye 7/a- cle 3S--3 NO <br /> Address Date CST Number <br />