Laserfiche WebLink
onsin <br /> of <br /> LaborundHu an Rel tions Industry, SOIL AND SITE EVALUATION REPORT Page_of_ <br /> Labor and Human Relations <br /> Division of Safety&Buildings in accord with ILHR 83.05, WIS.Adm. Code <br /> COUN <br /> Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include,but "o e_ <br /> not limited to vertical and horizontal reference point(BM),direction and%of slope,scale or PARCEL I.D.# <br /> dimensioned, north arrow, and location and distance to nearest road. <br /> APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED DATE <br /> PROPERTY OWNER: // <br /> �� <br /> PROPERTY LOCATION <br /> CU It e//LJ GOVT.LOTS ll4s 1/4,S��T y0 ,N,R /,/ E(oro <br /> OWNER's MAIL NG DRESS LOT# BLOCK# SUBD.NA7NEAR, <br /> # <br /> CITY,S AT IP CODE PHONE NUMBER ❑CITY VIS GE OWNWNEST ROA <br /> p t-'9/le tip• s5iaf s 3���3 c� K .� G .- �d� J` <br /> (�Q New Construction Use [54- Residential/Number of bedrooms [ ] Addition to existing building �— <br /> [ J Replacement [ ] Public or commercial describe <br /> Code derived daily Flow gpd Recommended design loading rate o 6 bed,gpd/ft2 . 7 trench,gpd/ft2 <br /> Absorption area required c��_bed,ft2 X63 trench,ft2 Maximum design loading rate bed,gpd/ft2 / 6'trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s) %moi It (as referred to site plan benchmark) <br /> Additional design/site considerations — <br /> Parent material Flood plain elevation, if applicable ft <br /> S=Suitable for system CONVENTIONAL MOUND IN ROUND PRESSURE AT-GRADE SSEM IN FILL H❑OLSING TANK <br /> U=Unsuitable fors stem 14S 1:1 U egu <br /> S ❑U S ❑U 0 S ❑U <br /> SOIL DESCRIPTION REPORT <br /> Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft <br /> in. Munsell Qu.Sz.Cont.Color Gr. Sz. Sh. Bed (Trerxi� <br /> f h <br /> 1..: <br /> Ground <br /> elev. <br /> 97,)ft. <br /> Depth to <br /> limiting <br /> factor <br /> Remarks: <br /> Boring # <br /> Ground <br /> elev. <br /> ft. <br /> Depth to <br /> limiting <br /> factor <br /> i <br /> Remarks: <br /> CST Name—Please rint/� Phone: <br /> Address <br /> /�sX 5 /c/ —Sim^ .�J G✓'Z— <br /> Signature <br /> ZSignature Date: CST Number: <br />