Laserfiche WebLink
Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page LOf <br /> Labor and Human Relations <br /> Division of Safety&Buildings <br /> ' in accord with ILHR 83.05, Wis.Adm. Code <br /> COUNTY <br /> Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include,but 8 U p h L <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 /> 3113- <br /> APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE <br /> PROPERTY OWNER: / PROPERTY LOCATION <br /> Al' /BOG zEl GOVT.LOT 1/4 1/4,S T C ,N,R 14 E( ow- <br /> PROPERTY OWNER':S MAILING ADDRESSLOQ# BLOCK# SUBD.NAME OR CSM# <br /> t9 c o R- �' YS SSM V-4 z2 <br /> CITY STyyTE :797v2 ZIP CODE PHONE NUMBER ❑C ❑VILLAGE OWN NEAREST ROAD <br /> �t�l W 14 ,4t w' . / ) 0?3 3�3 <br /> KNew Construction Use [ ] Residential/Number of bedrooms I [ ] Addition to existing building <br /> I ] Replacement [ ] Public or commercial describe <br /> Code derived daily flow gpd Recommended design loading rate bed,gpd/ft2 trench,gpd/ft2 <br /> Absorption area required bed,112 trench f 2 Maximum design loading rate bed,gpd/ft2 trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark) <br /> Additional design/site considerations PR I V <br /> Parent material ae'4C1[ba-e Flood plain elevation,if applicable ft <br /> S=Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK <br /> U=Unsuitable for s stem El ElU [:]S [:]U ❑S ❑U El El ❑S ❑U ❑S ❑U <br /> SOIL DESCRIPTION REPORT <br /> Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary RootsFBe <br /> D/ft <br /> in. Munsell Qu.Sz.Cont.Color Gr. Sz. Sh. Trench <br /> Ground <br /> elev - <br /> /&'�v ft. <br /> Depth to C <br /> limiting OF ILK f44 <br /> 7a7� <br /> Remarks: <br /> Boring# <br /> qq <br /> Ground <br /> elev. <br /> ft. <br /> Depth to <br /> limiting <br /> factor <br /> Remarks: <br /> CST Name:—Please Print <br /> C ', Phone: 7/ tr 2 c/C/^ 3 v 5 <br /> Address: r2o 3j l/Sr/� �Ja d Gtl `, <br /> Signature: Date: CST Number:_ <br />