Laserfiche WebLink
Wisconsin Department of Industry, SOIL AND SITE EVALUATION ®D (� 1� <br /> Labor and Human Relations n V I v of <br /> Division of Safety and Buildings in accordance with s. ILHR 83.09,Wis. Adm. Co <br /> Mach 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 <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. Pa el I.D.# <br /> 0a0--q334-6a- 7C <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)). /. <br /> Properh,Owner Property ation <br /> Govt.Lo S 1/4 1/4,643514y ,N,R lb E(or)9 <br /> Props Owner's Mailing Address Lot# Wock# Subd.Name or S # <br /> .55 3 170 <br /> City Stat6 Zip Code Phone Number ❑ City ❑ Village D4 Town Nearest Road <br /> LS IMN 55 1 ii I ( SM-631%2_4 <br /> ❑ New Construction Use: 9 Residential/Number of bedrooms _3 Addition to existing building <br /> 19 Replacement ❑Public or commercial-Describe: <br /> Code derived daily flowd Recommended design loading rate •s bed,gpd/ft2 -6 trench,gpd/ft2 <br /> Absorption area required gpbed,ft2_35a_trench,ft2 Maximum design loading rate bed,gpd/ft2trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s)��.G ft(as referred to site plan benchmark) <br /> Additional design/si considerations <br /> Parent material U11MAj- (A la' Flood plain elevation,if applicable Np ft <br /> S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank <br /> U = Unsuitable for system CXS ❑ U 1Z S ❑ U f0 S ❑ U NIS ❑ U I ® S ❑ u ❑ s ;9 U <br /> SOIL DESCRIPTION REPORT <br /> Boris # Horizon Depth Dominant Color Mottles Structure GPD/ft2 <br /> Boring in. Munsell Ou.Sz.Cont.Color Texture Gr.Sz.Sh. Consistence Boundary Roots Bed Trench <br /> t S 7 $ <br /> Ground <br /> L5 <br /> Depth to <br /> limiting <br /> fa or <br /> 7�in. <br /> Remarks: <br /> Boring # �, 9 0 Al 7y 7 $ <br /> 0-5 <br /> 2 , 2S D MI o -7 . � <br /> 3 ZM y <br /> Ground Q %X •7 a <br /> Zit. S b ew 8 s M -e <br /> Depth to , <br /> limiting <br /> fac r <br /> in. Remarks: <br /> CST Name (Please Print) Signature Q Telephone No. <br /> fcl�lil2p go P14»4_5 �`•! �Y'� �1S- g(o(� Llisl <br /> Addr s ate CST Number <br /> 2-'17(P0 357 �98� ti.11 54893 � 27�� Zz .151 <br />