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Wis <br /> of <br /> LaborandHu an Rel tions Industry, SOIL AND SITE EVALUATION REPORT Pae _ <br /> Labor and Human Relations g _Of <br /> Division of safety a Buildings in accord with ILHR 83.05,Wis.Adm. Code <br /> COUN7" <br /> i <br /> Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include,butev'U <br /> not limited to vertical and horizontal reference point(BM),direction and%of slope,scale or _ARCEL I.D.# <br /> dimensioned,north arrow,and location and distance to nearest road. <br /> APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWBYATE q <br /> PROPERTYOWNER: 4c (S r & <br /> PROPERTY LO/CATION <br /> 1�U 'e /,7��c�•e +^S a yv GOVT.LOT G 1/4 1/4,S3 5-T ale ,N,R 45- E(or)C <br /> PROPERTYOWNER':SMAIL191�jjj3�DDRE LOT# BLOCK# SUED.NAME OR CSM# <br /> s T <br /> CITY,STATE , ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE [MOWN NEAREST ROAD <br /> c v'- 6 r"u ./ <br /> D _New Construction Use [F] Residential/Number of bedrooms -7-L Addition toe 'sting building <br /> ( ] Replacement [ ] Public or commercial describe — <br /> Code derived daily flow gpd Recommended design loading rate + > bed,gpd/ft trench,gpd/fl2 <br /> Absorption area required W9' bed,ft2 0 2s-tench,ft2 Maximum design loading rate • 7 bed,gpd/ft trench,gpd/112 <br /> Recommended infiltration surface elevation(s) ft (as referred to site plan bench rk) <br /> Additional design/site considerations <br /> Parent material Flood plain elevation,if applicable <br /> S=Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE STEM IN FILL HOLDING TANK <br /> U=Unsuitable fors stem 54'S ❑U ®S ❑U �S ❑U ®S ❑U ms ❑U ❑S gill <br /> SOIL DESCRIPTION REPORT <br /> Boring# Horizon Depth Dominant Color Mottles ure StructF'Be'd <br /> D/ft <br /> Texture Consistence Barndary Roots <br /> n. Munsell Qu.Sz.Cont.Color Gr. Sz. Sh. <br /> Trerch <br /> o- S 7•s � ✓t`^-38 7 s IP -- /5 <br /> Ground <br /> elev. <br /> U2, ft. <br /> Depth to <br /> limiting <br /> factor <br /> 3gy <br /> Remarks: <br /> Boring# <br /> .: Cn-i 7.3 <br /> J j) sdK y+ df/ <br /> Ground <br /> elev.�ft. <br /> Depth to <br /> limiting <br /> faq r t, <br /> Remarks: <br /> T Name:-Please Print i y /m Phone: <br /> !sv 3 9 <br /> Address: <br /> Signature: <br /> Date: CST Number: <br />