Laserfiche WebLink
Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page_L ofo?, <br /> Labor and Human Relations <br /> Division of Safety&Buildings in accord with ILHR 83.05, Wis. Adm. Code <br /> COUNTY <br /> Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but <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 /> REVIEWED BY DATE <br /> APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION ✓ _ � <br /> PROPERTY OWNER: PROPERTY LOCATION <br /> B rian z, GOVE-LOT AI F 1/4 ,All,,11/4,S31�T � ,N,R E(or)W <br /> PROPERTY OWNER: AILI G ADDRESS „ / LOT# BLOCK# SUBD.NAME OR CSM# <br /> 1��1� .�oa <br /> CITY STATE � ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE KOWN NEAREST ROAD <br /> [ New Construction Use [ ) Residential/Number of bedrooms p q/a %ram [ ] Addition to existing building <br /> j ] 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,ft2 trench,ft2 Maximum design loading rate bed,gpd/ft2 trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s� or yh,er ft (as referred to site plan benchmark) <br /> Additional design/site con derations r �rr'rf <br /> Parent material Flood plain elevation, if applicable 4IA7: ft <br /> S=Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK <br /> U=Unsuitablefors stem ❑S ❑U ❑S ❑U ❑S ❑U ❑S ❑U ❑S ❑U ❑S ❑U <br /> SOIL DESCRIPTION REPORT <br /> Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft <br /> .................. <br /> in. Munsell Qu.Sz.Cont.Color Gr. Sz. Sh. Bed Trench <br /> ................. <br /> .................. <br /> ................. <br /> .. �. <br /> Ground <br /> elev. <br /> Depth to <br /> limiting <br /> factor <br /> Remarks: li' 8t'� �r nQ <br /> Boring # <br /> Ground <br /> elev. <br /> ft. <br /> Depth to <br /> limiting <br /> factor <br /> Remarks: <br /> CST Name:—Please Print K ( Phone: 715 6 53_ <br /> Address: WOOD CREEK RD. <br /> Signature: /+ �� Date: � � � CST Number: <br /> i. � ' 0 <br />