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Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page_of_ <br /> Labpr and Hulnan Relations <br /> Division or Safety a Buildings in accord with ILHR 83.05,Wis. Adm. Code <br /> COU 1,TY <br /> Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include,but -JaRg <br /> not limited to vertical and horizontal reference point(BM),direction and%of slope,scale or PARC EL I.D.# <br /> dimensioned, north arrow,and location and distance to nearest road. <br /> APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVI WED BYuD;\ <br /> � <br /> PROPERTY OWNER: PROPERTY LOCATION ll <br /> SERrt 5L.IRPRENRMr GOVT.LOT NE 1/4N� 1/4, IZT q(1 ,N,R 15 E(ore- <br /> PROPERTY <br /> or W� <br /> PROPERTY OW ER'. MAILING ADDRESS LOT# BLOCK# SUBD.NAME R CSM# <br /> 17-S5 t' AV. N . 5nVOL. P- Zu <br /> CITY,STATE ZIP CODE PHONE NUMBER []CITY ❑VILLAGE MOWN NEjREST ROAD <br /> P� r�oumi Mrs . S z ((012)559 - 2188 S Dns !0 0 <br /> [ ] New Construction Use Residential/Number of bedrooms Z [ ] Addition t existing building <br /> ] I Replacement [ ] Public or commercial describe <br /> Code derived daily flow SOO gpd Recommended design loading rale bed,g /ft2 — trench,gpd/ft2 <br /> As iSTI� rea required bed,ft2 trench,ft2 Maximum design loading rate — bed,g Ift2 trench,gpd/ft2 <br /> infiltration surface elevation(s) 91.q It (as referred to site plan benchmark) <br /> Additional design/site considerations <br /> Parent material�I ACI A L DR I r r Flood plain elevation,if applica le Nfl ft <br /> S=Suitable for system CO VENTIONAL MOUND IN GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK <br /> U=Unsuitable fors stem s ❑U EIS ❑U 0 0 ❑S ❑U ❑S ❑U ❑S ❑U <br /> SOIL DESCRIPTION REPORT <br /> Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft <br /> Boring # Horizon in. Munsell Qu.Sz.Cont.Color Gr. Sz. Sh. Bed Trends <br /> r.::;:: � [s <br /> s - % <br /> Ground <br /> 16lev. <br /> 1_6 ft. <br /> Depth to <br /> limiting <br /> f�to$ra.r <br /> LI <br /> Remarks: <br /> Boring# <br /> mmo <br /> 2`l`r< <br /> :....r` <br /> Ground <br /> elev. <br /> ft. <br /> Depth to <br /> limiting <br /> factor <br /> Remarks: <br /> CST Name:—Please Print 0� NS Phone: 71 VoI6 5 <br /> Address: i ) W S ] 5gS93 I Vo <br /> I6- <br /> ate: CST Number: <br /> 3 <br />