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wtonginDepa�UneentofIndustry, SOIL AND SITE EVALUATION REPORT Page—1of� <br /> Labor and Human Relations <br /> Divisionbf Safety&Buildings in accord with ILHR 83.05,WiS.Adm. Code <br /> FREVIEWED <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 Ddimensioned, north arrow,and location and distance to nearest road. DATE <br /> APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION <br /> PROP TY OWNER: PROPERTY LOCATION <br /> AD 7- G LG gam{$T 1/4 N bjl/4,S�T N,R <br /> PROPERTY OWNER':S MAILING ADDRESS LOT# BI OCK# SUBD.NAME OR CSM# <br /> jaa10 5aELt/ 4L--,g- "M I C5�/ vat a13 P 3 / <br /> CITY,STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE NOWN NEAREST ROAD <br /> aR v All 5 $30 (11.0 65634 3<0 wt E[ LLQ <br /> [ ] New Construction Use Residential/Number of bedrooms [ ] Addition to existing building <br /> K ReplacementPublic or commercial desait- <br /> Code derived daily flow 3CO gpd Recommended design loading rate r7 bed,gpd/ft2_,g_trench,gpd/ft2 <br /> Absorption area required 40C) bed,ft2 trench,ft2 Maximum design loading rate / bed,gpolft2 trench,gpd/it2 <br /> `r ft as referred to site Ian benchmark <br /> Recommended infiltration surface elevation(s) 9'a.-6 ( P ) <br /> Additional design I site considerations 04/D 6 <br /> Parent materialtL T�`L G Flood plain elevation,if applicable <br /> S=Suitable for System CONVENTIONAL MOUND IN- ROUND PRESSURE AT-GRADE SYSTEM,IN ILL HOLDING,�T,9�K <br /> U=Unsuitable for system <br /> S ❑U S ❑U S ❑U `�S ❑U ❑S ❑S " <br /> SOIL DESCRIPTION REPORT <br /> Depth Dominant Color Mottles Texture Structure Consistence Bouclary Roots GPD/ft <br /> Boring# Horizon in Munsell Qu.Sz.Cont Color Gr. Sz. Sh I Bed ITmnch <br /> :<:<:>::•:t.:< p 2 3� G 5 �G C S Z j1 4 <br /> s l � �r5 rm -7 <br /> � c <br /> Ground J7 �� ?�fyYL `�y I�jGl2 tryJ?i�i2 T-- CCS •7 ' <br /> glev. <br /> c�L{�"ft. <br /> Depth to <br /> limiting <br /> factor <br /> Remarks: R�trl� ° �,Z/ <br /> Boring# ' 0�8v 7S a 7 / lam n1vjr3 <br /> : sX "Z4" R- <br /> �< n <br /> .v �� g- 7 Sof <br /> � <br /> Ground m6 rZ <br /> elev., ;1 <br /> ft. <br /> Depth to <br /> limiting <br /> fact <br /> Remarks: <br /> CST Name:-Please Print L� P7�Q Phone: Z !j� L _5 <br /> Signature: / d <br />