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WisconsinDepartrtierxoflnduslry, SOIL AND SITE EVALUATION REPORT page�of <br /> Labor and=tons <br /> Division of Sa%V S Buntings in accord with ILHR 83.05,Wis.Adm. Code <br /> COU <br /> Attach complete site plan on paper not less than B 1/2 x 11 inches in size.Plan must include,but 610 A0# <br /> not limited to vertical and horizontal reference point(BM),direction and%of slope,scale or PARCEL I.D.e <br /> dimensioned,north arrow,and location and distance to nearest road. <br /> APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEVY EDBY DATE <br /> PROP RTYOWNER: PROPERTY LOCATION <br /> /► G lC4n1 bO$ GOvT.LOT qSV14SW114,4yT yo ,N,R /5(E(41 <br /> PR ,�OWNEg: MAILING AD SS LOTH BLOCKM SUBD.NAME O CSMA <br /> CITY,STATE my, KCL zip C01l�,�'PHON)NUMBER ,9 ❑CITY ❑VILLAGOE OWN NEARS �D <br /> ( ) New Construction Use [ j [/Rjeessiid�e�nt/iall//Number of bedrooms [ ) Addition to a fisting building <br /> ( [ Replacement [ ) Public or commercial describe <br /> Code derived daily flow gpd Recommended design loading rate bed,giodIftf—trench,gpdm2 <br /> Absorption area required bed,112 trench,ft2 Maximum design loading rate bed,gpd/t tr ch,gpd/ft2 <br /> Recommended infiltration surface elevation(s) ft (as referred to site plan bench ark) <br /> Additional design/site considerations <br /> Parent material Flood plain elevation,if applicable ft <br /> S=Suitable for system CONVENTIONAL I MOUND IN-GROUND PRESSURE AT-GRADE YSTEM IN Fl HOLDING TANK <br /> U=Unsuitable fors 0 ❑U D 0 ❑S ❑U ❑S ❑U Ds ❑U ❑S ❑U <br /> Sys /r1xev/cvj SOIL DESCRIPTION REPORT <br /> Boring# Horizon Depth Dominant Color Mottles Texture Structure ConsistedRoots GPD/ft <br /> in. Munsell Chu.Sz.Cont.Color Gr. Sz. Sh. Bed ITranch <br /> 0-3 �.sKv <br /> off- 3-t 7.s YR y/ hOnrL <br /> Ground <br /> eV/ N <br /> 7 lft. <br /> Depth to <br /> Writing <br /> facto <br /> Remarks: Ar4k 10 Y E /ei'7-470 v <br /> Boring# <br /> Ground <br /> elev. <br /> ft. <br /> Dept to <br /> limiting <br /> facto <br /> i <br /> r 1 <br /> Remarks: <br /> T Name:-Please Print 11 - /( PM Phone:Addr _ <br /> ess: a3 &6-6 creek Or s y$ <br /> Signature: I Date, -lb T ber: <br />