Laserfiche WebLink
Wisconsin Department of 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 /> COUNTY <br /> Attach complete site plan on paper not less than 8 1/2 x 11 inches in size.Plan must include,but �rN <br /> not limited to vertical and horizontal reference point(BM),direction and%of slope,scale or PARCEL I.D.# g ,I� <br /> dimensioned, north arrow,and location and distance to nearest road. 0 33cQ— `0�@ —vA <br /> 000 <br /> APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DAT D <br /> PRO ERTY OWNER: 1 PROPERTY LOCATION - I <br /> a/L) Af cel 4lu G YT.LOT 1/4Sc 1/4,S 6 T N,R �6 E(or CW <br /> PROPERTY OWNERS MAILING ADDRESS OT# BLOCK# SUBD.NAME OR CS # .,,tt <br /> CITY,STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE EXOWN NEAREST ROAD <br /> [ ] New Construction Use [>� Residential/Number of bedrooms c-;;,? [ J Addition to existing building <br /> (� Replacement [ ] Public or commercial describe — <br /> Code derived daily flowgpd Recommended design loading rate :bed,gpd/ft2_,�Ctrench,gpd/ft2 <br /> Absorption area required `fad bed,ft2 3> _ trench,ft2 Maximum design loading rate bed,gpd/ft2 t�9 trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark) <br /> Additional design/site considerations —` <br /> Parent materialFlood plain elevation,if applicable //J f} ft <br /> S=Suitable for system ONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK <br /> U=Unsuitable fors stem S ❑U AS ❑U FS ❑U as ❑U ❑S KU <br /> SOIL DESCRIPTION REPORT <br /> Depth Dominant Color Mottles Structure ffRootsD/ft <br /> Boring# Horizon in. Munsell Qu.Sz.Cont Color Texture Gr. Sz. Sh. Consistence Bat-day TrenchGround <br /> elev. <br /> f �ft. <br /> Depth to <br /> limiting <br /> factor <br /> Remarks: <br /> Boring # 11W <br /> / �7 <br /> Hca <br /> Ground <br /> � <br /> elev./ <br /> 5&b ft. <br /> Depth to it IRA <br /> limiting <br /> factor ,/ <br /> -;,,72 <br /> Remarks: <br /> CST Name:Please Print yu � / Phone: <br /> Address: <br /> .1 !"�itJ lam✓ 5 �'�,_ <br /> Signature: Date: CST Number: <br />