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Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page_of_ <br /> Labor and Human Relations <br /> Division of safety a Buildings - in accord with ILHR 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 '�C Q <br /> not limited to vertical and horizontal reference point(BM),direction and%of slope,scale or PAR EL I.D.# <br /> dimensioned,north arrow,and location and distance to nearest road. - 1'1- ca-300 <br /> APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY apy. DATE <br /> 8-1-9y <br /> PROPERTY OWNER: PROPERTY LOCATION <br /> Bog GOVT.LO ';�a1/4 1/4, I? T 4 ,N,R ILf E(OR <br /> PROPERTY OWNERS MAILING ADDRESS LOT# I BLOCK# <br /> 2 0 Z15 FI1_1R9_5 <br /> CITY,STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE [g]fOWN NEAREST ROAD <br /> SZE W[ • ( ) SC61T 9tAGLAsn <br /> I DQ New Construction Use p<J Residential/Number of bedrooms 2� [ ] Addition t existing building <br /> [ ] Replacement [ ] Public or commercial describe <br /> Code derived daily flow gpd Recommended design loading rate 1.2 bed,g ft2 1-7- trench,gpd/ft2 <br /> Absorption area required 375 bed,ft2 375 trench,ft2 Maximum design loading rate 1 .2- bed,g /ft2 1.2- trench,gpd/ft2 <br /> Recommended infiltration surface elevations) . 103.q It (as referred to site plan benchmark) <br /> Additional design/site considerations 32- y- 21 ' Mo"W o <br /> Parent material C LAC IA L- Flood plain elevation,if applicab NA It <br /> S=Suitable for system CONVENT ROUND jIN-GROUND PRESSURE. AT-GRADE SYSTEM IN FILL HOLDING TANK <br /> U=Unsuitable for s stem ❑S )ZSI U l�S ❑U ❑S U ❑S U ❑S U ❑S U <br /> SOIL DESCRIPTION REPORT <br /> Boring# Horizon Depth Dominant Color Mottles Texture Structure consiste rice Boundary Roots GPD/ft <br /> z ; $: <br /> in. Munsell Qu.Sz.Cont Color Gr. Sz. Sh. Bed Trench <br /> k <br /> l i 1 0 '1 <br /> JOIK 3 <br /> g :< i 7.30 7.S y1tS/4 ps h[ C <br /> Ground 3 0- 'l.5 R <br /> elev. <br /> q.3ft. <br /> Depth to <br /> limiting <br /> factor <br /> Remarks: <br /> Boring # <br /> O-5 IDK _3ZZ ^, <br /> s os ow MI c 5 <br /> 2 - 35 7-5y9 51q �`— �s 0+5 M) CS 2f s •� <br /> Ground 3 3S•`!d 7-SYR, `I q C2d 5c.1 7- 6k- <br /> elev. <br /> 101--oft. <br /> Depth to <br /> limiting <br /> factor rr <br /> -3s <br /> L L <br /> Remarks: I <br /> CST Name.—Please Print In` RRn p�K'N f Phone: 'S 7_ /S <br /> Address: 2 /760 w 3S WrrSM2, W I. S LM3 <br /> Signature: Date: r7- _ p J CST No <br />