Laserfiche WebLink
Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page of <br /> Labor'ard Human Relations <br /> Division of safety&Buildings in accord with ILHR 83.05,Wis.Adm. Code <br /> COUNTY n <br /> Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include,but <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 /> x <br /> APPLICANT INFORMATION–PLEASE PRINT ALL INFORMATION REVIEWED BY DATE <br /> PROPERTYOWNER: PROPERTY LOCATION <br /> 9^&�nr /J7 L GOVT.LOT o2 1/4 1/4,S F T y ,N,R (T—E(00 <br /> PROPERTY OWNER':S MAILING ADDRELOT# I BLOCK# SUoyBD.NAME OR CSM# <br /> L <br /> CITY,STATE ZIP CODE PHONE NUMBER []CITY ❑VILLAGE MOWN NEAREST ROAD <br /> t <br /> [ ] New Construction Use [ ] Residential/Number of bedrooms ,Z Addition to existing building <br /> I ] Replacement pQ Public or commercial describe <br /> Code derived daily flow /50gpd Recommended design loading rate__, __bed,gpd/ft2 W trench,gpolft2 <br /> Absorption area required bed,ft2 trench,ft2 Maximum design loading ratebed.gpd/ft2_LF trench,gpolft2 <br /> Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark) <br /> Additional design/site considerations 904 fR SiTC l�eYli"I A-)LCN <br /> Parent material " Er- Flood plain elevation,if applicable ft <br /> S=Suitable for systemC NVENTIONAL MOUND IN- ROUND PRESSURE AT- RADE SYSTEM IN FILL HOLDING TANK <br /> U=Unsuitable fors stem S ❑U S ❑U S ❑U S ❑U ft's El U [I S U <br /> SOIL DESCRIPTION REPORT <br /> Boring# Horizon Depth Dominant Color Mottles Texture Structure Consistence B ary Roots GPD/ft <br /> in. Munsell Qu.Sz.Cont.Color Gr. Sz. Sh. Bed Trends <br /> < <br /> ' 414 G54_5 1fkj <br /> Ground 7,r 72 <br /> elev, <br /> /ntr-t2ft. <br /> Depth to <br /> limiting <br /> factor <br /> 12� <br /> Remarks: <br /> Boring# <br /> Ground <br /> elev. <br /> ft. <br /> Depth to <br /> limiting <br /> factor <br /> Remarks: <br /> CST Name:—Please Print �r Phone: <br /> Address: 1/c ' � �f{ti" �Q� 6Jr' <br /> Signature: /` Date: �6 /�/ CST Number: <br />