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Wisconsin Departmentof Industry, SOIL AND SITE EVALUATION REPORT Page-Lof- <br /> Labor and Hum,+n Relations <br /> Division of Safety&Buildings in accord with ILHR 83.05,Wis.Adm. Code <br /> t <br /> Attach complete site plan on paper not less than 81/2 x 11 inches in size.Plan must include,but CDU <br /> not limited to vertical and horizontal reference point(BM),direction and%of slope,scale or PARCE I.D.# ^ \ <br /> dimensioned, north arrow, and location and distance to nearest road. -,214 <br /> APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIE ED BYZW� DATE <br /> PROPE OWNER: yy� �r PROPERTY LOCATION <br /> GOVT.LOT � 1/4 sE1/4, T.7g ,N,R/I I3{Sr)W <br /> PR OWNEIT:S M ILINGADDRE LOT# BLOCK# SUBD.NAME 0 CSM# <br /> o s C �f <br /> C SAT ZIP CODE PHONE NUMBER []CITY ILLAGE OWN NEAREST ROAD <br /> / IMF Y, 5 tr %' <br /> [ ] New Construction Use Residential!Number of bedrooms lle?L [ ] Addition to Existing building <br /> Y Replacement [ ] Public or commercial describe <br /> Code derived daily flow 4100 god Recommended design loading rate /.; bed,gpd/ft2jR trench,gpoltt2 <br /> Absorption area required 00 bed,ft2 00 trench,ft2 Maximum design loading rate /.�bed,gpd/fl2,6 2 trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s) 7 4f ft (as referred to site plan benchmark) <br /> Additional design/site^^considerations <br /> Parent material l��A C/ L ®/�/2r 1` Flood plain elevation,if applicable ft <br /> S=Suitable for system CONVENTIONAL I MOUND IN-GROUND PRESSURE I AT-GRADE SYSTEM IN FILL HOLDING TANK <br /> U=Unsuitable for s stem ❑S U X[S ❑U ❑S U ❑S ]�U ❑S U ❑S U <br /> SOIL DESCRIPTION REPORT <br /> Boring# Horizon Depth Dominant Color Mottles Texture Structure Consisten Bourlcay Roots GPD/ft <br /> in. Munsell Qu.Sz.Cont Color Gr. Sz. Sh. Bed Trends <br /> 2 <br /> A <br /> 0-T 19YR3 — 5icI- IFsB MVS 3 <br /> B $-� /C 3`f< a0 58 ScL MAB K M FR D Vt/ 1 F <br /> Ground CU— $ </ M IQ SCS. M M V F — - <br /> elev. <br /> Depth to <br /> limiting <br /> factor <br /> T— <br /> Remarks: <br /> Boring# 7,S>'R3 Sic /F-58K W F A S � F � <br /> . � <br /> .m ��: <br /> C n <br /> Ground D 5Uy m ` P sc, - M hi VF — <br /> elev. <br /> q It. <br /> Depth to <br /> limiting <br /> factor rf <br /> Remarks: a 60 <br /> CST Name:—Please Print KEN SCHMITZ INC. Phone: <br /> Address: 22835 Sc "G 1111 <br /> Signature: LA <br /> (7WIMP15) 46&2434 Date: CST Number: <br /> it Ar <br />