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Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page i of 3 <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 _PAR_CE L I.D.# <br /> dimensioned, north arrow,and location and distance to nearest road. <br /> APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIE ED a DATE <br /> PROPERTYOWNER: '�^"_�l_ PROPERTYLOCATION <br /> ,41 `f"��p P.l" GOVT.LOT WE 1/4 1`1Z1fr1/4,S T 3S ,N.R 14 W)W <br /> PROPER OWNER':SMAILING ADDRESQ -E6F# BLOCK# SUBD.NAME O CSM# <br /> t 2Z,5 1 Z2..A SF. Pw.tner.. CS m°Lt4 1 <br /> CITY,STATE ZIP CODE PHONE NUMBER ❑CITY (]VILLAGE ®TOWN NEAREST ROAD <br /> Inc' YY1n 553-71 ( ) �usr� Lane <br /> New Construction Use pQ Residential/Number of bedrooms �Py.t�N [ ] Addition to existing building <br /> Replacement [ ] Public or commercial describe <br /> Code derived daily flow gpd O,b Recommended design loading rate bed,gpd/ft2 ` trench,gpd/ft2 <br /> Absorption area requir W bed,ft2 trench,ft2 Maximum design loading rate gibed,gpd/It2 . to trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s) 4-7.3' ft (as referred to site plan benchmark) <br /> Additional design/site considerationcs�Ak rn cW% a U*A+eoej ik''k <br /> Parent material 41 AG ALGA¢jt' Flood plain elevation,if applicable ft <br /> S=Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE I AT-GRADE SYSTEM INFILL HOLDING TANK <br /> U=Unsuitable for system ❑S MU ❑S ®U ❑S OU ❑S ®U 0 ZLU ❑S oil <br /> on>_y SOIL DESCRIPTION REPORT <br /> Boring# Horizon Depth Dominant Color Mottles Texture Structure Consistence Baxtdary Roots GPD/ft <br /> in. Munsell Cu.Sz.Cont Color Gr. Sz. Sh. Bed Tnartdt <br /> gii��.flz <br /> I t . 7> a& - 8 <br /> Z. -d5" -7.5_VX 11/ye a .n) 11W.5bAe .r7.- eco of.7 . T <br /> Ground 3 7.59'Z '✓ 49"'e AJ &)>151; n� /� � • (o <br /> fellev.0. `�SA dQ tit r ho <br /> Depth to <br /> limiting <br /> factor <br /> 4 3.0 <br /> Remarks: i r R; $ter <br /> Boring# <br /> a43 <br /> Ground <br /> elev. <br /> n. <br /> Depth to <br /> limiting <br /> factor <br /> Remarks: <br /> CST Name:—Rease Print EPTIC & EXCAVATION Phone: <br /> Address HCR 59, x <br /> Signature: opumorDate: CST Number: <br /> ,c2 (715j635-7482 V2� 4s 1723"'1 <br />