Laserfiche WebLink
Wisconsin Department of Commerce SOIL AND SITE EVALUATION <br /> Division of Safbty 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 u/`ILJ C. <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. Parcel_I.D.# <br /> 03�2- 5-3a3- 01-3690 <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)). 9- <br /> Property Ownerf / Property Location / <br /> O h Govt.Lot Nom' 1/4hJ�1/4,S Q 3 T ,N,R E(or)e)_ <br /> Property Owner's Mailing Address Lot# Block# Subd-tdame or CSM# <br /> C2l yS/ cl©-14 7, 7 VhG P173-17 <br /> City State Zip Code Phone Number ❑ City ❑ Village Town Nearest Road <br /> om e A'--F Syoasi s 5 7 <br /> L-New Construction Use: CE�desidential/Number of bedrooms � Addition to existing building <br /> ❑ Replacement ❑Public or commercial-Describe: 0 ' <br /> Code derived daily flow 0 O gpd _ Recommended design loading rate bed,gpd/ft2__& 49�trench,gpd/f12 <br /> Absorption area required —?S 0 bed,ft2 ;2S franc 2 Maximum design loading rate _bed,gpd/ftz�trench,gpd/ft2 <br /> C-figRecommended infiltration surface elevation(s) ft(as referred to site plan benchmark) <br /> Additional design/site considerations — / .r <br /> Parent material G1,4e i FI—I C[ /`i�/ Flood plain elevation,if applicable,/L� — ft <br /> S = Suitable for system Conventional IMound In-Ground Pressure AT-Grade System in Fill Holding Tank <br /> U = Unsuitable for system ❑ s AU S ❑ U ❑ S IKu 1 ❑S b4'U ❑S OU ❑ S [?�u <br /> SOIL DESCRIPTION REPORT <br /> Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2 <br /> in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. Bed Trench <br /> % <br /> p /fir 9 <br /> 9IrZft. <br /> Depth to <br /> limiting <br /> facto <br /> --:Zin. <br /> Remarks: <br /> Boring # <br /> X37 7 S , � <br /> SsI'V <br /> Ground <br /> elev. <br /> 9�ft <br /> Depth to <br /> limiting <br /> factor <br /> in. Remarks: <br /> CST Name (Please Print) Signature Telephone No. <br /> Address Date CST Number <br /> /.Sox .S/ �`e•.� a✓� �Y�7 5''� -9'% a.2� G � <br />