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of <br /> LaboraidHu an Rel tions Industry, SOIL AND SITE EVALUATION REPORT Page_of <br /> Labor and Human Relations <br /> Division bf Safety 8 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 Au4A)L� <br /> 77 <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. la –4208—Oa foe <br /> APPLICANT INFORMATION–PLEASE PRINT ALL INFORMATION REVIEWE DATE <br /> PROPERTY OWNER: PROPERTY LO T ON f <br /> (/=�i>l/UIS 1/4 U/1/4,S 8 T ,N,R E(or <br /> PROPERTY OWNER':S MAILING ADDRESS LOT# BLOCK# SUBD.NAME OR CSM# <br /> 000, 13X I — <br /> CITY,STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE OWN NEAREST ROAD <br /> KNew Construction Use Residential/Number of bedrooms c;z_ [ ] Addition to existing building <br /> I ] Replacement [ ] Public or commercial describe <br /> Code derived daily flower gpd Recommended design loading rate _bed,gpd/ft2��trench,gpd/ft2 <br /> Absorption area required jt3&bed,ft2 / trench,ft2 Maximum design loading rate + bed,gpd/ft2 trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s) `S 2,6 r f ft (as referred to site plan benchmark) <br /> Additional design/site considerations Mfg AI <br /> Parent material � �ZQ j Flood plain elevation,if applicable ft <br /> S=Suitable for system CONVENTIONAL MOUND IN- ROUND PRESSURE AT-GRADE SYSTEM I FILL HOLDI G NK <br /> U=Unsuitable fors stem S ❑U S ❑U S ❑US ❑U ❑S NU ❑S MIJ <br /> SOIL DESCRIPTION REPORT <br /> Depth Dominant Color Mottles Structure GPD/ft <br /> Boring# Horizon Texture Consistence Boundary Roots <br /> in. Munsell Qu.Sz.Cont.Color Gr. Sz. Sh. Bed Trench <br /> Ground <br /> elev. u <br /> "ft. <br /> Depth to <br /> limiting <br /> f Ctor <br /> u <br /> Remarks: *T7' <br /> Boring# / G /n <br /> Ground q�Caf N?b2,- MTV, � c 7 <br /> elevr i' <br /> ft. <br /> Depth to <br /> limiting <br /> factor 11 <br /> ?—�ld�• Remarks: <br /> CST Name:—Please Print a Phone: <br /> Address: 14 s f� <br /> Signature: Date: CSTyugigpr: . <br />