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Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Pageof <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,but6t{-n e i r <br /> not limited to vertical and horizontal reference point(BM),direction and%of slope,scale or PARCEL 1.D.# <br /> dimensioned, north arrow,and location and distance to nearest road. <br /> APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE <br /> PRCAERTYO NER: / PROPERTY LOCATION <br /> d f/lcc GOVT.LOT 111,E114 SE 1/4,S 7 T ,N,R E(or` I <br /> PRO ERTY OWNER'S MAILING ADD ESS LOT# I BLOC # SUBD.NAME OR CSM# <br /> CITY,STg�}TE ZIP CODE PHONE NUMBER [:]CITY ILIAGE WOWN NEAREST R9AD <br /> /e V <br /> Ile SV3-699 ,zc.CK- Se i 6 en Rol- <br /> pQ New Construction Use pC] Residential/Number of bedrooms a [ ] Addition to existing building <br /> ] Replacement [ ] Public or commercial describe iVIA- <br /> Code derived daily flow 3 00 gpd Recommended design loading rate •6 3 bed,gpd/ft2 . 7-?trench,gpd/ft2 <br /> Absorption area required z1,,29 bed,ft2 37s trench,ft2 Maximum design loading rate • 7 bed,gpd/tt2 -S trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s) q6-_a ' ft (as referred to site plan benchmark) <br /> Additional design/site considerations Some S/0.0 e a Her 4 f # <br /> -/f v n. Q - Qar%^S -4— <br /> Parent <br /> Parent material Gr a c i"/ c/vi.-P t Flood plain elevation, if applicable_ �ft <br /> S=Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK <br /> U=Unsuitable fors stem Ca'S C:]U Ers ❑U ®"S ❑U 5aS 11U ❑S RU ❑S J'U <br /> SOIL DESCRIPTION REPORT <br /> Depth Dominant Color Mottles Structure GP /ft <br /> Boring # Horizon in. Munsell Qu.Sz.Cont Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed 'Trench <br /> O <br /> `T <br /> .< am <br /> og Y-o26 /0 YR6 a c0 • fs <br /> Ground /0>,R Ic s6•k /, -'r — IYO 7 4 <br /> elev. <br /> ft. <br /> Depth to <br /> limiting <br /> factor <br /> Remarks: 4c /iu ori n <br /> Boring# f 7 <br /> Ow /S s6 f' A / Cl_r a co 7 <br /> Ground` 0 0 Y VA9 — G J A Tn,' — 7C • 7 -� <br /> elev, <br /> Depth to <br /> limiting <br /> fac or <br /> 7 <br /> Remarks: 4 c 4� h o{ 60Ylh t Sa <br /> CST Name:—Please Print Phone <br /> Address:6 s— XPi-7e Qrn c/ Rel• e k fed- 4✓%I 3 <br /> Signature: "�-_ _ Date: CST Number: <br />