Laserfiche WebLink
Wisconsin Department of Commerce SOIL AND SITE EVALUATION <br /> Division of Safety and Buildings Page of <br /> Bureau of Integrated Services 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. Farce I.D.# <br /> ©/ Ya?C/ 15- `JPO <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)). a — <br /> Properly Owner Property Location <br /> CA Arl f; C �� Govt.Lot p2 1/4 1/4,S TXO ,N,R/S E(or(W <br /> Property Owner's Mailing Address Lot# Block# Subd.Name or CSM# <br /> 5"a S S, ;c-A 49Ue- – — <br /> City State Zip Code Phone Number ❑ City ❑ Village 1S Town Nearest Road L <br /> er e P X L s Rc oiJ Lov,� .C/il` e <br /> f New Construction Use: CgResidential/Number of bedrooms -3 Addition to existing building <br /> ❑ Replacement ❑Public or commercial-Describe: <br /> Code derived daily flow /�gpd Recommended design loading rate L7bed,gpd/ft2 ? trench,gpd/ft2 <br /> Absorption area required i �3 bed,n2 -5-(//3 rtrrench,ft2 Maximum design loading rate . -7 bed,gpd/ft2 �8 trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s)_ 7 i_A5_ ft(as referred to site plan benchmark) <br /> Additional design/site considerations <br /> Parent material G jig a6:6 ' Flood plain elevation,if applicable ft <br /> S = Suitable for system Conventional rM,orund In-Ground Pressure AT-Grade System in Fill Holding Tank <br /> EJ <br /> U = Unsuitable for system s ❑ U S ❑ c <br /> U l� ❑ u 18 S ❑ u TKS ❑ u ❑ s U <br /> SOIL DESCRIPTION REPORT <br /> Boring# Horizon Depth Dominant Color Mottles Texture Structure GPD/ft2 <br /> Consistence Boundary Roots <br /> in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. Bed Tre�nych <br /> 1,PLIY4— C-5 <br /> N m / <br /> 7 b� .7 �� Y� S' G� �7 S c o sea <br /> Ground 3 6X 7,_T*X' <br /> elev. <br /> nrit <br /> Depth to <br /> limiting <br /> Kin. <br /> Ktin. <br /> Remarks: <br /> Boring# <br /> Ground <br /> elev41 <br /> Q�n. ' <br /> Depth to <br /> limiting , <br /> factor <br /> ;_, in. Remarks: <br /> CST Name (Please Print) Signature Telephone No. <br /> Address r Date CST Number <br />