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Wisconsin Dep artment of Industry, SOIL AND SITE EVALUATION REPORT Page of <br /> Labor and Human Relations <br /> Divisiori of Safety&Buildings in accord with ILHR 83.05,Wis.Adm. Code <br /> COUNTY <br /> Attach complete site plan on paper not less than 81/2 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 FrARCE L I.D.# <br /> dimensioned, north arrow,and location and distance to nearest road. —pd-dC0 <br /> APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIVED BY DATE <br /> PROPERTY OWNER: PROPERTY LOCATION <br /> R N R R N GOVT.LOT 1/4 1/4,S 7T Ila ,N,R E(or)W <br /> PAIPR PERTY <br /> OWNER'S MAILING ADDRESS LOT# BLOCK# SU NAME 0 CSM# <br /> SRT olw 57• Z 't" V.V. <br /> CITY,STATE ZIP CODE PHONE UMBER ❑CITY ❑VILLAGE OWN N REST ROAD <br /> . 5512 ( 12J 3 9353 colt p RP- <br /> �}New Construction Use•44 Residential/Number of bedrooms 3 [ ] Addition to axisting building <br /> j ] Replacement [ ] Public or commercial describe <br /> Code derived daily Bow�gpd Recommended design loading rate_Lbed,gpd/ 2 • `d trench,gpd/ft2 <br /> Absorption area required_4 13 —bed,ft2 S43 trench,ft2 Maximum design loading rate •7 bed,gpd/it2 •� trench,gpd/ft2 <br /> J <br /> Recommended infiltration surface elevation(s) I 1 It (as referred to site plan benct mark) <br /> Additional design/site considerations <br /> Parent material 4;64—Z141— Flood plain elevation, if applicable IYA ft <br /> S=Suitable for system NVENTIONAL I MOUND IN ROUND PRESSURE AT-GRADE s�YSTEM IN FILL HOLDIN T NK <br /> U=Unsuitable fors stem S ❑U S ❑U N'S F-1U 03 S ElUJ S ❑U E]S U <br /> SOIL DESCRIPTION REPORT <br /> Boring# Horizon Depth Dominant Color Mottles Texture Structure Consistence Bounday Roots GPD/ft <br /> in. Munsell Qu.Sz.Cont.Color Gr. Sz. Sh. Bed Trerxtl <br /> «:< 'y I (0 5 3 Z. r Ms Ons Kk C5 <br /> 4 4 <br /> Ground <br /> elev. <br /> 9$. ► ft. <br /> Depth to <br /> limiting <br /> facjqr rt <br /> Remarks: <br /> Boring # ] <br /> •5 V93 2 MS OMs E. <br /> Ml CS 2t/ 7 g <br /> 2r� 8 <br /> 7•S R �- H 5 DMS M I <br /> Ground <br /> elev. <br /> Depth to <br /> limiting <br /> factgr <br /> Remarks: <br /> CST Name:—Please Print 11—*9 D tLO&IM Phone: / _ 6- IS <br /> dress: 7 �O n7 D 3 J <br /> Signature: -� Date: CST Number: <br /> r�iAt� 9 ZS- 9 0 <br />