Laserfiche WebLink
Wisconsin Department of Industry, SOIL AND SITE EVALUATION <br />Labor and Human Relations <br />Division of Safety and Buildings in accordance with s. ILHR 83.09, Wis. Adm. Code <br />Page of <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 $2Ijg ► l <br />percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. # <br />034 Too 01 3oo <br />APPLICANT INFORMATION - Please print all information. Reviewed by I Date <br />Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). �Af <br />Property Owner >A n �/ `' Property Location <br />K P5ifzi-W-5 Govt. Lot 1/4 1/4,S36 T `{0 ,N,R f E (or W <br />Property Owner's Mailing Address Lot # Block# Subd. Name or CSM# <br />Sq 30 FINES END R - 2�3 I Pies <br />City State Zip Code Phone Number t' Nearest Road <br />l>J S-t�rZ �/ 54 93 (? -S )$66- ?3❑City S'1 u� O Village Town P1 JE5 i No <br />❑ New Construction Use: gResidential / Number of bedrooms Z Addition to existing building <br />'R Replacement ❑ Public or commercial - Describe: <br />Code derived daily flow 500 gpd <br />Depth <br />in. <br />Recommended design loading rate 7 bed, gpd/ft2 g <br />trench, gpd/ft2 <br />Absorption area required y2q bed, ft2 37S trench, ft2 <br />Maximum design loading rate • 7 bed, gpd/ft2 • 8 <br />trench, gpd/ft2 <br />Recommended infiltration surface elevation (s) <br />. Z <br />ft (as referred to site plan benchmark) <br />Bed Trench <br />Additional design/site considerations Co RL <br />umQr �N -SITE <br />7.S 8 3/7- <br />Parent material GLACIAL nQ1 F -r <br />►Ns <br />Flood plain elevation, if applicable A ft <br />N <br />S = Suitable for system <br />Conventional <br />:�_4 <br />Mound <br />2 <br />In -Ground PressureAT-Grade <br />System in Fill <br />Holding Tank <br />U = Unsuitable for system <br />NS [:1U <br />XS ❑ U <br />3 <br />® S ❑ U <br />1 '9] S❑ U <br />gj S U <br />s <br />❑ S N�'U <br />Boring # <br />Ground <br />lev. <br />��ft. <br />Depth to <br />limiting <br />factor <br />.5 -9 --in. <br />Boring # <br />I2 <br />Ground <br />L3 <br />Ift. <br />Depth to <br />limiting <br />SOIL DESCRIPTION REPORT <br />Horizon <br />Depth <br />in. <br />Dominant Color <br />Munsell <br />Mottles <br />Qu. Sz. Cont. Color <br />Texture <br />Structure <br />Gr. Sz. Sh. <br />Consistence <br />Boundary <br />Roots <br />GPD/ft2 <br />Bed Trench <br />I <br />0-S <br />7.S 8 3/7- <br />r--- <br />►Ns <br />S <br />dl <br />CS <br />:�_4 <br />.7 S <br />2 <br />sf6-i <br />A,fs <br />1 <br />Cs <br />M <br />17 .8 <br />3 <br />5`S <br />y <br />C2d R5 <br />s <br />yrs <br />rrI <br />H <br />8 <br />Remarks: _F_ __ <br />1 <br />0 - S <br />7-S\49 -3 <br />Ms <br />. I A <br />Z- 'S-71 <br />.SR qlqr---- <br />-t in. Remarks: <br />CST Name (Please Print) <br />�IC�AIC�17 <br />Address <br />7 � 7 (o <br />0 <br />SiTelephone <br />Tele/ne <br />�nls _ /'S- gbh- /S' <br />Date CST Number <br />6.6-1-7 _347o <br />