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Wisconsin Department gfIndustry, SOIL AND SITE EVALUATION REPORT Page,/—of-3— <br /> Labor and Human Relations <br /> Division of Safaty 8 Buildings in accord with Il-HR 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 PARCEL I.D.# <br /> not limited to vertical and horizontal reference point(BM),direction and/,of slope,scale or /�vO <br /> dimensioned, north arrow,and location and distance to nearest road. IE y—3f�0Q,4- <br /> APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DAT <br /> 513 <br /> PROPERTY OWNER: PROPERTY LOCATION <br /> GOVT.LOT 5 1/e 1/4,S/0 T 34 ,N,R/5/ E(c(5 <br /> PERTY OWNERS MAILING ADDRESS LOT# BLOCK# S <br /> ROPU D.NAME R CSM# <br /> a Faf t ju� (ISm �. 4 P. X05 <br /> CITY,STATE ZIP ODE PHONE NUMBER ❑CITY []VILLAGE LjjrOWN NEAREST ROAD <br /> (X54315— d <br /> [ ] N" <br /> Construction Use [ Residential/Number of bedrooms [ ] Addition to existing building T— <br /> I ieplacement [ I Public or commercial describe `-- <br /> Code derived daily flow _gpd Recommended design loading rate.:bed,gpd/ft2�trench,gpd/ft2 <br /> Absorption area required _bed,ft2c_trench,ft2 Maximum design loading rate . bed,gpd/ft2�_trench,gpd/ft2 <br /> R.� <br /> Recommended infiltration surface elevation(s) a ft (as referred to site plan benchmark) <br /> Additional design/site considerations <br /> Parent material Q- ;A o Flood plain elevation,if applicable A)A- ft <br /> rS=�Uun'Stlabloertore system COydENTIONAL MO IN. UNDPRESSURE AT- DE SYSTEM IN L HOLDING T <br /> s stem C9 S ❑U S ❑U S ❑U ZS ❑U ❑S U ❑S <br /> SOIL DESCRIPTION REP RT <br /> Depth Dominant Color Mottles Texture Structure ConsistenceBcurx�ry Roots GPD/ft <br /> Boring# Horizon in. Munsell Qu.Sz.Cont.Color Gr. Sz. Sh. Bed Trend <br /> rI L 6 <br /> 5 <br /> Ground yL Q rYl <br /> elev. <br /> Depth to <br /> limiting <br /> tac <br /> 7 <br /> Remarks: <br /> Boring# <br /> 7.5 o.J" 2�1 r F2 cS <br /> LS <br /> Ground <br /> 7o <br /> elev. <br /> Depth to <br /> limiting s <br /> factor <br /> �7n <br /> Remarks: <br /> CST NamWIease Print Phone: 714—' 4/4 <br /> _ 1 <br /> Address. <br /> Signature: te: CST Numb �, <br />