Laserfiche WebLink
Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page!of 3 <br /> Labor and Human Relations <br /> Division of safety 8 Buildings in accord with ILHR 83.05,Wis.Adm. Code <br /> COUNTY <br /> Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include,but V-A-,,L----7T— <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. 0/a 6 /of DO 0 <br /> APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BYDATE <br /> 9-,2 -99 <br /> PROPERTY OWNER: PROPERTY LOCATION <br /> �/I,IJ I�Cyi9� GOVT.LOT 4$W14 51.11/4,S k T Z f o ,N,R (�_E(o <br /> PROPERTY OWNERS {L� �ES$ �` LOT# BLOCK# SUBD.NAME OR CSM# <br /> CITY,STATE �f "7ZIIPP CODE PHONE NUMBER ❑CITY ❑VILLAGE ObWN INEAREST ROAD <br /> o 45 n1S D hE /` S5Y22( 7/)t 533r-/R9-5 -7 Z-con/ IS�oncmFi°cv� , <br /> New Construction Use [ ] Residential/Number of bedrooms r [ J Addition to existing building <br /> j ] Replacement [ ] Public or commercial describe <br /> Code derived daily Bow gpd Recommended design loading rate bed,gpd/ft2 r trench,gpd/ft2 <br /> Absorption area required ed,ft2 37S trench,ft2 Maximum design loading rate bed,gpi:101 6' trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s) 92/-( /1 ft (as referred to site plan benchmark) <br /> Additional design/site considerations <br /> Parent material 4;Ci(-011A-e- L/07"- Flood plain elevation,if applicable =—fit <br /> S=Suitable for system CONVENTIONAL MOUNDIN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK <br /> U=Unsuitableforsstem [IS ❑U ❑S ❑U EIS ❑U ❑S ❑U ❑S ❑U ❑S ❑U <br /> SOIL DESCRIPTION REPORT <br /> Depth Dominant Color Mottles Structure GPD/ft <br /> Boring# Horizon Texture Consistence Botxdary Roots <br /> In. Munsell Qu.Sz.Cont.Color Gr. Sz. Sh. Bed Trends <br /> DI-6" 7, sy/z Y �-5 D SG nr C b <br /> A Z, s l F .7 <br /> �: ,. N <br /> Ground <br /> eley. rr <br /> ft. <br /> Depth to <br /> limiting <br /> factor <br /> Remarks: P.- 7- <br /> Boring#Boring# C�1445e, 11/r ? rg <br /> 0ft5e� '0V <br /> Ground <br /> ft. f <br /> Depth to CS y <br /> limiting a'1 o — 91/r S' <br /> �r. <br /> Remarks: PIT <br /> CST Name:—Please Print b�-"4e'� D Phone: <br /> Address: � � Dr91— uV p -1, <br /> Signature: Date: 2 / CST Number: <br /> l 2��z f7 <br />