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WisconsinDepartmerttofIndustry, SOIL AND SITE EVALUATION REPORT Page of <br /> Labor and Human Relations <br /> Division of Safety&Buildings in accord with ILHR 83.05,Wis.Adm. Code <br /> COU <br /> Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include,but u <br /> not limited to vertical and horizontal reference point(BM),direction and%of slope,scale or PARCEL I.D.If <br /> dimensioned, north arrow,and location and distance to nearest road. <br /> APPLICANT INFORMATION–PLEASE PRINT ALL INFORMATION REVIE D / E <br /> PROPERTY OWNER: PROPERTY LOCATION /� <br /> K E N GOVT.LOT S– 1/4 1/4,S [ T 39 ,N,R ��( E(ol& <br /> PROPERTY OWNERS MAI LINGADDRESS BP.LAAMEO CSM# <br /> 2069 Go. Ro • c1Z lal <br /> CITY,STATE P CODE PONE NUMBER VILLAGE OWN NEAREST ROAD <br /> SPo ER 1. 5 DI ( ) ❑CITY K . Rfc r= L-x. <br /> [ ] New Construction Use I ] Residential/Number of bedrooms [ ] Addition to xisting building <br /> Replacement X Public or commercial describe 30 SEAT R Z 139 14o g , Z S /pj <br /> Code derived daily flow $7O gpd Recommended design loading rate • 7 bed,gpd trench,gpd/ft2 <br /> Absorption area required I2_y3 bed,ft2 I0 SS trench,ft2 Ma rimum design loading rate •j bed,gpd/ trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s) LoWEK 108•B UPPER 1I0.eft (as referred to site plan bench ark) <br /> Additional design/site considerations/ <br /> Parent material . `y Lfl CJp L_ DRI J:T" Flood plain elevation,if applicable NA ft <br /> S=Suitable for system CONVENTIONAL M NO IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING��aaNK <br /> U=Unsuitable for s stem ®S ❑U S ❑U 21 S ❑U U S ❑U 14 S ❑U ❑S ,ESI U <br /> SOIL DESCRIPTION REPORT <br /> Depth Dominant Color Mottles Structure GPD/ft <br /> Boring# Horizon Texture Cons sten Boundary Roots <br /> in. Munsell Qu.Sz.Cont Color Gr. Sz. Sh. Bed Trerdl <br /> (0 '7 M5 OMS MC5 �1 <br /> 2 b 9s 7.5 VR 4lq MS OMs Mf r — INt g <br /> Ground <br /> elev. <br /> Depth to <br /> limiting <br /> factor <br /> > 95 <br /> Remarks: <br /> Boring# <br /> t� I 0 -4 *7•5R *3/7- M5 om5oi H [ CS 2-M 1 I •S <br /> 2 - MS oms MI ^ �nn 7 .� <br /> Ground <br /> elev. <br /> 110.5 ft. <br /> Depth to <br /> limiting <br /> factor <br /> > 0 <br /> Remarks: s <br /> CST Name:—Please Print 104PKv 0f !/✓S Phone: _ fo $ <br /> Address: Its <br /> 27760 lqwv 35- <br /> Signature: Date: CST Number: <br /> 34?o <br />