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Wisconsin Department of Indus", 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 /> COUNTY <br /> Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include,but U <br /> Wff <br /> not limited to vertical and horizontal reference point(BM),direction and%of slope,scale or PARC I.D.If <br /> dimensioned, north arrow,and location and distance to nearest road. Qoi- 4 0 <br /> APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION R VIE I 1ED DATE <br /> PROPERTY OWNER: PROPERTY LOCATION <br /> N GOW-1:0T S'F- 1/4,SF',1/4,S q T I. ,N,R- 17 E(o(0 <br /> PROPERTY OWNER4 MAILING A DRESS LOT# LOCK SUED.NAME 0 SM <br /> (01(o w 7 / �— Yol, <br /> CITY,STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE &OWN NEAREST ROA <br /> 5 O I f4wV <br /> DQ New Construction Use [kl Residential/Number of bedrooms 3 [ ] Addition to i ixisfing building <br /> I ] Replacement [ ] Public or commercial describe <br /> Code derived daily flow SO gpd Recommended design loading rate 7 bed,gpd 2 . $ trench,gpd/ft2 <br /> Absorption area required Go ?) bed,l 5(05 trench,l Maximum design loading rate bed,gpd/ 2 -a trench,gpd/n2 <br /> Recommended infiltration surface elevation(s) i•7- Rep• S 1. 36 It (as referred to site plan bench nark) <br /> Additional design/site considerations <br /> Parent material gLACIQL DR19r Flood plain elevation, if applicable n <br /> S:Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK <br /> U=Unsuitablefors stem �S ❑U ®S ❑U ®S ❑U �S ❑U �S ❑U ❑S �U <br /> SOIL DESCRIPTION REPORT <br /> Boring# Horizon Depth Dominant Color Mottles Texture Structure Consisteric D Boundary Roots GPD/ft <br /> in. Munsell CU.Sz.Cont.Color Gr. Sz. Sh. Bed Trench <br /> 0 ' 7•S a 3 7- �� MS MS CS ZV� '1 <br /> Z 5 $ ).S IZ 4/4 HS W r OMs Ml CJ 7-M 1 8 <br /> Ground 3 19.40 7.S AE f, M5 r OMIS5 MI CS ZM .-I $ <br /> elev. <br /> �$3ft. yo-G3 7.5 a q& <br /> Depth to <br /> imitlng <br /> factor •r <br /> Remarks: <br /> Boring# <br /> 6. 2,0 MSW r OMS M) Cs nn <br /> 3 20.40 -7.6V a 4 ro Msw r OM55 MI e3 2rl ? .$ <br /> Ground <br /> elev. q 10-79. 7-5-49 44 145 014S51 N <br /> qQ o n. <br /> Depth to <br /> limiting <br /> factor „ —t <br /> 1-75- <br /> Remarks: <br /> CST Name:—Please Print f� RRD O / Phone: 71S- I Va 6- YIS <br /> Address: Z776o Avy 3SE l- SYi893 <br /> Signature: Date: CST Number: <br /> mud S6 -`l6 � o <br />