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Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT <br /> Page of <br /> Labor and Human Relations <br /> Division of Safety&Buildings in accord with ILHR 83.05,Wis. Adm. Code COUN Y <br /> Aftach complete site plan on paper not less than 8 1/2 x 11 inches in size.Plan must include,but PARCEL I.D.#`\ <br /> not limited to vertical and horizontal reference point(BM),direction and%of slope,scale or '96_Q I S 01— <br /> n <br /> I_ <br /> dimensioned, north arrow,and location and distance to nearest7oad. REVI ED BY DATE <br /> APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION -3-�7 <br /> PROPERTY OWNER: PROPERTY LOCATION / <br /> SOH Rlsa�v GOVT.LOT 114 114,S�� T d ,N,R �lo E(o W <br /> PROPERTY OWNER':S MAILING A DRESS LOT# BLOCK# SUBD.NAME R CSM# <br /> IS LFMOND D • 2No 0 o RKS t11ft2 PttdES <br /> CITY,STATE ZIP CODE (HONj NUMBER ❑CO []VILLAGE OWN ARECLUQ �l��R <br /> p NNR <br /> New Construction Use-K Residential/Number of bedrooms <br /> Addition t existing building <br /> r] Replacement ( I Public or commercial describe <br /> Code derived daily flow gpd Recommended design loading rate •1 bed,g Ift2 •$ trench,gpdift2 <br /> S ch,ft2 Maximum design loading rate •� bed,g /ft2 trench,gpolft2 <br /> Absorption area required _bed,ft2tre_ 9 <br /> Recommended infiltration surface elevation(s) 94.4 /per q7--7- ft (as referred to site plan be mark) <br /> Additional design I site considerations ft <br /> Parent material G LA('I R t_ 'U IZI kT Flood plain elevation,if applicable NA <br /> $=Suitable for System CONVENTONAL M UND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING T NK <br /> U=Unsuitable for s stem S ❑U S ❑U •R S ❑U S ❑U S ❑U ❑S U <br /> SOIL DESCRIPTION REPORT <br /> Structure Roots GPD/ft <br /> Depth Dominant Color Mottles Texture Consistence Y ged Trerct <br /> Boring# Horizon in Munsell Qu.Sz.Cont Color Gr. Sz: Sh. <br /> O ' fo `(.S 1Z <br /> l "r wts DMS ��� 2PA 1 .8 <br /> Ground <br /> elev. <br /> 12.C-1 ft. <br /> Depth to <br /> limiting <br /> factgr_r <br /> L <br /> Remarks: P <br /> Boring# <br /> R 2 M a <br /> 2 2 b• g3 y �-- <br /> MS pM5 M <br /> >au a c <br /> Ground <br /> elev. <br /> c4.D ft. <br /> Depth to <br /> limiting <br /> factor$ <br /> .00 '0 <br /> Remarks: Phone: <br /> CST Name:—Please Print p l �D F/c 71'/S <br /> ddress: 2. 77(o D }�w 35 WE85('=Q W 1 . -;y 00" <br /> Date: CST Number: <br /> Signature: 36-7 <br />