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Wisconsin DepartmentofIndus", SOIL AND SITE EVALUATION REPORT Page_L of <br /> Labor and Human Relations <br /> Division of Safety 8 Buildings in accord with ILHR 83.05,Wis. Adm. Code <br /> COUNTYQQ <br /> (-JUS JV L� <br /> Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include,but #PARCEL I.D. <br /> not limited to vertical and horizontal reference point(BM),direction and%of slope,scale or f� # 06 <br /> dimensioned, north arrow,and location and distance to nearest road. <br /> APPLICANT INFORMATION—PLEASE PRINT ALL INFORMATION REVIEWED BY DATE <br /> t .3 6 <br /> PROPERTY OWNER: PROPERTY LOCATION <br /> GOVT.LOT 1/4 1/4,S 13 T N,R !S E(or)W <br /> PROPERTY OWNER':S Mp ILING ADDRESS LOT# BLOCK# SUBD.NAME OR CSM# , <br /> lv6 A ��('L 1T ' 7/?L a, 4 �' r 6kr 7 s Ti2L�r <br /> CITY,STATE Z1PCODEPHONE NUMBER ❑CITY []VILLAGE WOWN ROAD <br /> �f3n/2b M $� . 0 rr w <br /> [ ] New Construction Use Residential/Number of bedrooms [ ] Addition to existing building <br /> ,Replacement [ ] Public or commercial describe <br /> Code derived dairy flow .3PO gpd Recommended design loading rate 7 bed,gpd/ft2 - trench,gpd/ft2 <br /> Absorption area required & bed,ft2 trench,ft2 Maximum design loading rate 7 bed,gpd/ft2 $ trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s) << ft (as referred to site plan benchmark) <br /> Additional design/site considerations /V9/1/C <br /> Parent material 61401h:( IoP6FT Flood plain elevation,if applicable ft <br /> S=Suitable for system C VENTIONAL M ND IN- ROUND PRESSURE AT RADE SY TEM IN FILL HOLDING TANK <br /> U=Unsuitable for s stem S ❑U S ❑U S ❑U VS ❑U WS ❑U ❑S U <br /> SOIL DESCRIPTION REPORT <br /> Depth Dominant Color Mottles Texture Structure ConsistenceBoundary Roots GPD/ft <br /> Boring# Horizon in. Munsell Qu.Sz.Cont Color Gr. Sz. Sh. Bed Trench <br /> a<<< 7 . 3 <br /> G <br /> Ground <br /> eleY. „ <br /> W ft. <br /> Depth to <br /> limiting <br /> factor.., <br /> Remarks: hoiyE <br /> Boring# <br /> now <br /> Ground <br /> elev, If <br /> ft. <br /> Depth to <br /> limiting <br /> factor. <br /> 7-4� Remarks: �� <br /> CST Name:—Please Print Phone: 71j_` <br /> 1J_ <br /> Address: fla 7 cs• cS/'� S f2/J �b /t' i u1 <br /> T Number: <br /> Signature: �f" � at ' // J/ 1�� �✓'" <br />