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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 /> COUN <br /> Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include,but IAETr <br /> not limited to vertical and horizontal reference point(BM),direction and%of slope,scale or FARCE I.D.# <br /> dimensioned, north arrow,and location and distance to nearest road. <br /> APPLICANT INFORMATION—PLEASE PRINT ALL INFORMATION REVIEVfEDJYn DATE <br /> PROPERTY OWNER: PROPERTY LOCATION <br /> KEV[N LAKSO4 GOVT.LOT F_112.Z1r NE 1/4,S 9 T 0 ,N,R 15 E(or(W) <br /> PR05 TYOWNEASTLIINN�NRESS LOT# BLOCK# <br /> 9z Es <br /> CITY STATE ZIP ODE PyONE NUMBER []CITY ❑VILLAGE OWN NEAREST ROAD <br /> LS M►J. S 09 (b►Z)8Zs Z0,11 ''''' Sq n_ <br /> [ J New Construction Use [ ] Residential/Number of bedrooms nJ 1yy [ J Addition to existing building <br /> [ J Replacement [ ] Public or commercial describe <br /> Code derived daily flow gpd Recommended design loading rate NA bed,gpd trench,gpd/ft2 <br /> Absorption area required_ f�bed,ft2 trench,ft2 Maximum design loading rate_AH bed,gpd 2 trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s) qA ft (as referred to site plan benchmark) <br /> Additional design/site considerations NA <br /> Parent material CgWIAL. DgIfT Flood plain elevation, if applicable It <br /> S=Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK <br /> U=Unsuitable fors stem ❑S ❑U ❑S 11U 11 ❑U ❑S ❑U ❑S ❑U EIS [3U <br /> SOIL DESCRIPTION REPORT <br /> Boring # Horizon Depth Dominant Color Mottles Texture Structure Consisten Boundary Roots GPD/ft <br /> in. Munsell Qu.Sz.Cont Color Gr. Sz. Sh. Bed Trench <br /> O'� 7.7732 �— Ms oMs MI Cs 2rf ,? <br /> P?` $ <br /> 7.5 It q14 r�_ Ms OMs MI cs 1 Y <br /> Ground 7.5 R q If 5 R q% 15 omn Mvfr ^- S <br /> lev. <br /> Depth to <br /> limiting <br /> logo$ \ <br /> CA <br /> Remarks: <br /> Is <br /> Boring# <br /> `Q... <br /> >a <br /> Ground <br /> elev. <br /> ft. <br /> Depth to <br /> limiting <br /> factor <br /> Remarks: <br /> ST Name:—Please Print ICN RoDPki�S Phone. '715• 66. /S• <br /> Address: 2 few 3S /V 1. 9261-CR Wl • S 815 <br /> {7 <br /> Signature: Date: S CST Number: <br />