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Wisoopsin Department of Industry, SOIL AND SITE EVALUATION REPORT �I Page J_of 3 <br /> Labor aZ.Human Relations <br /> Division of Safety 8 Buildings in accord with ILHR 83.05,Wis.Adm. Code <br /> COU f' <br /> Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include,but y ' ue <br /> not limited to vertical and horizontal reference point(BM),direction and%of slope,scale or PARCEL I.D.# <br /> dimensioned, north arrow,and location and distance to nearest road. <br /> APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE <br /> I /0- <br /> PROPERTYOWNER: PROPERTY LOCATION <br /> L GOVT.LOT /x/1/4 NIt)1/4,S T �'V ,N,R /Y E(or <br /> PROPERTY OWNERS MAILINGADDRESSLOT BLOCK# SUBD. AMEO CSM# <br /> aKP If �s s V7 190-19 <br /> CITY,STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE [MOWN N AREST ROAD <br /> 4 S Gt;r w-z -5 to (7/S) -1-5 22 -SS he <br /> p(f New Construction Use K] Residential/Number of bedrooms [ ] Addition to e isfing building <br /> [ ] Replacement [ ] Public or commercial describe 1 <br /> Code derived daily flow 30tn> gpd Recommended design loading rate • 7 bed,gpd/ft2 S trench,gpd/ft2 <br /> Absorption area required 4/a9 bed,ft2 7�7_5 trench,ft2 Maximum design loading rate gibed,gpd/tt -9' trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s) '?3 -/d'r It (as referred to site plan bench ark) <br /> Additional design/site considerations G 0,r)v i ax V0 <br /> Parent material r�10 rG / 0444 L-1c S Flood plain elevation,if applicable lvl,4 ft <br /> S=Suitable for system CONVENTIONAL I MOUNDIN-GROUND PRESSURE AT-GRADE YSTEM IN FILL HOLDING TANK <br /> U=Unsuitable fors stem ®S ❑U WS ❑U <br /> OS ❑U J$I S ❑U S NU [:Is DaU <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 Trench <br /> Pam <br /> v.. .. 3-7a 7 5YR Al, S <br /> Ground <br /> elgv. <br /> R5-(, ft. <br /> Depth to <br /> limiting <br /> actor ,. <br /> Remarks: AA 6 r <br /> Boring# <br /> l -3 �sYR y ! 'y"' 5 7 : , � <br /> 3 7, 5 YR 5�� one 5 ( a � <br /> Ground <br /> elev, v <br /> Depth to <br /> limiting <br /> factor2' a„ <br /> v- '( <br /> Remarks: <br /> CST Name:-Please PrintQ u r Phone: a5,? <br /> 5 9 73(0 <br /> Address: a5 a3 66 e«k 04bu , cum 5e193 <br /> Sgnature: �� �/�/ Date: 9 - a _(� 35umber: <br />