Laserfiche WebLink
wisconsin Department of Industry, SOIL AND SITE EVALUATION <br /> Labor and Human 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 0&41"tj <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. Parel <br /> 06 <br /> APPLICANT INFORMATION- Please print all information. Reviewed by Date /y <br /> Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). <br /> Property Owner Property Location <br /> O U C d Govt.Lot 3 1/4 1/4,S y T U() ,N,R/6 E(or(o <br /> Property Owner's Mailing Address Lot# Block# Subd.Name or CSM# <br /> A/ Yds/ w Y G 3 i3®,,. 7 :P. - <br /> City State Zip Code Phone Number ❑ City ❑ Village Town Nearest Road <br /> S OON a/� GcJ�t" O «OD )EYP= 07 <br /> ❑ New Construction Use: Residential/Number of bedrooms 22 Addition to existing building <br /> it1`5111- eplacement ❑Public or commercial Describe: <br /> Code derived daily flo Op gpd Recommended design loading ratebed,gpd/ft2��trench,gpd/ft2 <br /> Absorption area required y�bed,n2 trench,ft2 Maximum design loading rate_ bed,gpd/fl2�trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s) �� ft(as referred to site plan benchmark) <br /> Additional design/siteco^considerations -- <br /> Parent material rm.14< /� Flood plain elevation,if applicable et1 A-n <br /> S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank <br /> U Unsuitable for system WS ❑ U S ❑ U RS ❑ U igs ❑ U 1 % ❑ U ❑ S OU <br /> SOIL DESCRIPTION REPORT <br /> Boren # Horizon Depth Dominant Color Mottles Structure GPD/ft2 <br /> Boring in. Munsell Qu.Sz.Cont.Color Texture Gr.Sz.Sh. Consistence Boundary Roots Bed Trench <br /> -6 ,3 �s49s G <br /> Ground <br /> elev. za <br /> �n. <br /> Depth to <br /> limiting <br /> factor <br /> Remarks: <br /> Boring# <br /> -to 8 <br /> p� <br /> Ground <br /> elev <br /> Depth to <br /> limiting <br /> factor <br /> ;?%Q in. Remarks: <br /> CST Name (Pie a Print) Signature Telephone No. A �� <br /> 7, 1:P7 Y9-, <br /> Address ( Date CST Number <br />