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 �/1� <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. parcel I.D.# <br /> 01.2 C) <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(l)(m)). 5/ 6 <br /> Property Owner ^ / Property Location / <br /> Govt.Lot 1/4 1/4,S�2 S—T �le,N,R/j E(KW, <br /> Property Owner's Mailing Address Lot# Block# &ubd�-Name or CSM# <br /> A6'� �,- S-;,� -7 — V1 yO a39' <br /> City , State Zip Code Phone Number <br /> ❑ City ❑ Village 54-Town Nearest Road <br /> Sire t i I w,r- s-vs'Ja ( ) f<_%s o Srt G <br /> ❑ New Construction Use: 5taesidential/Number of bedrooms aZ Addition to existing building <br /> replacement ❑Public or commercial-Describe: r J <br /> Code derived daily flow—'70 ii gpd Recommended design loading rate,zbed, d/ft2 • 6 <br /> gp trench,gpd/ftz <br /> Absorption area required !�!,/F bed,ft23 7strench,ftz <br /> Maximum design loading rate r 7 bed,gpd/ftz '- trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s) � ft(as referred to site plan benchmark) <br /> Additional design/site considerations <br /> Parent materials/,.* C;^/ C/ Flood plain elevation,if applicable Z ft <br /> S = Suitable for system I <br /> Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank <br /> U Unsuitable for system I XS ❑ U X'S ❑ U ❑ U s ❑ U ms ❑ U ❑ s XU <br /> SOIL DESCRIPTION REPORT <br /> Boring# Horizon Depth Dominant Color Mottles Structure GPD/ft2 <br /> in. Munsell Ou.Sz.Cont.Color Texture Gr.Sz.Sh. Consistence Boundary Roots <br /> f d Bed , Trench <br /> zy <br /> Ground <br /> elev. <br /> Depth to <br /> limiting <br /> factor <br /> Remarks: <br /> Boring If <br /> 7,5 /r';;4C <br /> Ground <br /> elev. <br /> Depth to <br /> limiting <br /> factor <br /> � Xin. Remarks: <br /> CST Name (Please Print) Signature Telephone No. <br /> W�d� lQq <br /> Address r loor Date CST Number <br /> .4f d.r si S sr� ti s 5�f 7� '�/­/ -98- 3 �3 <br />