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,Wisconsin Department of Indus", SOIL AND SITE EVALUATION REPORT Page_Loft_ <br /> Labor and Human Relations <br /> Division of Safety 8 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 PARCEL I.D.# <br /> dimensioned, north arrow,and location and distance to nearest road. 19 5?d- (111?-U-- O <br /> APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED DATE <br /> PROPERTY OWNER: PROPERTY LOCATION <br /> t <br /> --F -s f YeLA-, GOVT.LOT (0 1/4 1 1/4,S IliT +0 ,N,R ly Slew <br /> PROPERTY OWNER':S MAILING ADDRESS LOT# I BLOCK# I SUBD.NAME OR CSM# <br /> t?• o. Sox I'1+ 1 <br /> CITY,STATE ZIP CODE PHONE NUMBER ❑CITY ❑ AREST OADn <br /> 000eX .c�� 5`I8o? ( 1 (035-8oc2.. �S <br /> pQ New Construction Use bQ Residential/Number of bedrooms Z at 3 [ ] Addition to existing building <br /> [ ] Replacement [ ] Public or commercial describe <br /> Code derived daily flow 45D gpd Recommended design loading rate N.T bed,gpd/ft2 N.'r trench,gpd/ft2 <br /> Absorption area required_4A.-bed,ft2 / k. trench,ft2 Maximum design loading rate gibed,gpd/ft2--"44—trench,gpd/ft2 <br /> Recommended infiltration surface elevatign(s) AD!, la: A 'I K ft (as referred to site plan benchmark) <br /> Additional design/site considerations A.-6m Elev: 1040_n' w"Do"%e tom• Dnv-Trca_ <br /> Parent material ae ; c. Flood plain elevation,if applicable -fil)w ft <br /> S=Suitable Tor System CONVENTIONAL I MOUND IN-GROUND PRESSURE AT-GRADESYSTEM IN FILL HOLDING TANK <br /> U=Unsuitable fors stem ElS RU ElS ®U ❑S ®U ❑S ®U ❑S KU 1$S ❑U <br /> SOIL DESCRIPTION REPORT <br /> Boring# Horizon Depth Dominant Color Mottles Texture Structure Consistence BaLndary Roots GPD/ft <br /> in. Munsell Qu.Sz.Cont Color Gr. Sz. Sh. Bed Trench <br /> 7 55+R 4'a6x PWP- ew '.P15 <br /> }; <br /> 2 5'�Z8 7.5'/R 'Vl �r+ass e. Y'�G.iY i73bAC ,J,- CA.) <br /> 1 SYRS/f3' r <br /> Ground -tlwa. h sbtA rn•tr M4) a V119- <br /> elev. . czp fo- nn f� <br /> 7.Syet`I 4 -e-ky- � T a Zj sbK mai- -19- <br /> Depth to <br /> limiting <br /> factor <br /> as" <br /> Remarks:` I t�'eb St.o(x.u/ tip' <br /> Boring# 3.t <br /> sYZ 31x. I- 5b Krn r <br /> 44 }: <br /> I�sb K 1"4 cal s <br /> $rf5Ymvs • <br /> Ground 3 Q"`6 T.SYR 4/q <br /> elev. <br /> 9-7.o ft. <br /> Depth to , <br /> limiting <br /> factor <br /> for � <br /> YL � c <br /> rr Remarks: <br /> CST Name:—Please Print' SEPTIC 8r EXCAVATION Phone: <br /> Address: HCR 59, Box 478d <br /> Signature: SPNI"l, 5-4801 Date: CST Number: <br /> (715)635.7482 t qs <br />