Laserfiche WebLink
Wisconsin Department of Industry, SOIL AND SITE EVALUATION <br /> Labor and Hdman Relations Page of <br /> Division of Safety and Buildings in accordance with s. ILHR 83.09, Wis. 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 and <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. parcel I.D.# <br /> 3 ��C3 - dace <br /> APPLICANT INFORMATION- Please print all information. viewredby Date <br /> Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). <br /> Property Owner L n Property Location <br /> r S �eef'),4 Govt.Lot g1/4s 6' 1/4,S 7 T3 N,R/� E(or)oi <br /> roperty Ownbes Mailing Address Lot# Block# Subd.Name or CSM# <br /> City State Zip Code Phone Number <br /> ❑ City El Village Town Nearest Road <br /> a� ws������,,,111111��_�&C, (60� )37� Y��' '�/t 6 <br /> , New Construction Use: residential/Number of bedrooms l Addition to existing building <br /> 1:1 Replacement Public or commercial-Describe: <br /> Code derived daily flow gpd Recommended design loading rate ped,gpd/ft2 trench,gpd/ft2 <br /> Absorption area required "C1 bed,ft2 —2 JC�trenc//h//ft2 Maximum design loading rate . gybed,gpd/tlz o C� trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s) qZT T it(as referred to site plan benchmark) <br /> Additional design/site <br /> considerations <br /> Parent material 1��i7C j�4, jr/'f 7 4- Flood plain elevation,if applicable 14— ft <br /> S Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank <br /> U = Unsuitable for system %S ❑ U ❑ U KS ❑ U ❑ U ' ❑ U ❑ S 5441 <br /> SOIL DESCRIPTION REPORT <br /> Boring# Horizon Depth Dominant Color Mottles Structure GPD/ft2 <br /> Texture Consistence Boundary Roots <br /> in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. Bed , Trench <br /> Ground <br /> elev. <br /> Depth to <br /> limiting <br /> factor <br /> Remarks: <br /> Boring # <br /> 02 2 -7o2 /-7 <br /> Ground <br /> elev. <br /> �ft. <br /> Depth to <br /> limiting <br /> factor <br /> 7�inin. Remarks: <br /> CST Name (Please Print) Signature Telephone No. <br /> Address Date CST Number <br /> Qo s / Sires.,% S 87� '3� ?•-0a :274,_�9 <br />