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WiisconsinDepartinentofIndustry, SOIL AND SITE EVALUATION REPORT Page { of <br /> Labor and Human Relations <br /> Division of Safety&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 IBM),direction and%of slope,scale or PARCEL I.D.# <br /> dimensioned, north arrow,and location and distance to nearest road. CX B- - - <br /> APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVI WED DATE <br /> PROPERTY OWNER: PROPERTY LOCATION <br /> SoC ZAri-�cm- GOVT.LOT 1/4 1/4, Z T 3$ ,N,R t+ fW W <br /> PROPERTY OWNER'S MAILING ADDRESS LOT# BLOCK# SUBD.NAME R CSM <br /> ll 10 R fJRK f cQ" rink <br /> CITY,STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE MOWN NEAREST ROAD <br /> A V.)•. 54'656 ( ) o LAKE <br /> [ ] New Construction Use hQ Residential/Number of bedrooms 2- [ ] Addition to existing building <br /> bQ Replacement [ ] Public or commercial describe <br /> Code derived daily Bow 3oc gpd Recommended design loading rate a bed,gv ft ,�trench,gpd/ft2 <br /> Absorption area required T bed,tt2 ins n trench,ft 2 Maximum design loading rate " bed,g ft2 trench,gpd/tt2 <br /> Recommended infiltration surface elevation(s) (as referred to site plan beni hmark) <br /> Additional design/site considerations m I <br /> Parent material_ 9*g%va _ d 6�4 Flood plain elevation,if applicabl /6uT ft <br /> S=Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK <br /> U=Unsuitable fors stem I Els ®U ❑S ®U [IS CRU ❑S ®U ❑S 91U �S ❑U <br /> SOIL DESCRIPTION REPORT <br /> Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bourclary Roots GPD/ft <br /> in. Munsell Qu.Sz.Cont Color Gr. Sz. Sh. Bed jTfendn <br /> 1 7" "1.5 m'W D in a t mabK • %;-j Coy t2j . 5 .(n <br /> -F14 5y <br /> q '2.. 7-15" '7.SYR 1 } 1V% ha ,t A rn iC eJ; 0.4) � $ <br /> ezv s sfg;e/t o <br /> Ground 5 15- '7.,5YR 41+ 4ro 1.0.71 (►1 <br /> elev. <br /> �{ft. <br /> Depth to <br /> limiting <br /> factor <br /> LL1 <br /> rr <br /> Remarks: <br /> Boring# <br /> aJ { lo" -7. 5YR-3o tF -''O- L M5bK ✓1 } Cal It/7 5 '•io <br /> c: <br /> Z 2 Io—t sYR I + tl+�o ► a k ,off msb K ew; 6- <br /> w <br /> Ground <br /> elev. <br /> ft. <br /> Depth to <br /> limiting <br /> factor <br /> Remarks: <br /> T Name:—Please Print �C Phone: <br /> Address: HCR 59, Box 4784 <br /> Signature: OPWIMI, Date: CST Number: <br /> (71511MAIR cri 5 45 r43665 <br />