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Wisconsin Department of industry, 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, C" <br /> but �wue <br /> not limited to vertical and horizontal reference point(BM),direction and%of slope,scale or PARCEL I.D.If 1 <br /> dimensioned,north arrow,and location and distance to gearest road. �O-wo -04--10(3 <br /> APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE ' <br /> PROPERTY OWNER: PROPERTY LOCATION <br /> E NE#?/ 4 Al XWE GOVT.LOT 14.2 1/4 1/4,S I b T q0 ,N,R I(D E(or)W <br /> PROPERTY OW R':S MAILING ADDRESS LOT# BLOCK# SUBD NAME R CSM# <br /> fo73 I13y7- AV- (2G; � 4 <br /> CITY,STATE ZIP CODE PHONE NUMBER ❑CITY []VILLAGE OWN NEAREST ROAD <br /> 5A?%ROt l W t . 54SIZ ( ) o R>7. <br /> New Construction Use Residential/Number of bedrooms Z [ ] Addition to existing building <br /> ( ] Replacement [ ] Public or commercial describe <br /> Code derived daily flow 300 gpd Recommended design loading rate _bed,gpd/ft2 -S trench,gpd/ft2 <br /> Absorption area required 47-9 bed,ft2 375 __trench,ft2 Maximum design loading rate • 1 bed,gpd/ft2 A trench,gpd/ft2 <br /> Recommended inh1lration surface elevation(s)­- �5-S' ft (as referred to site plan benchmark) <br /> Additional design/siteconsiderations A 2945 CuT Aft r 2 <br /> & <br /> Parentmaterial ACIAL DRIFT Flood plain elevation, if applicable 14A It <br /> S=Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE A -GRADE SYSTEM IN FILL HOLDING TANK <br /> U=Unsuitable fors stem NS ❑U ImS ❑U ®S ❑U RS 0 WS ❑U ❑S RU <br /> SOIL DESCRIPTION REPORT <br /> Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft <br /> ram n. Munsell Qu.Sz.Cont Color Gr. Sz. Sh. Bed Trench <br /> I <br /> Ground <br /> ev. <br /> ft. <br /> Depth to <br /> limiting <br /> fact7 oQ .. <br /> Remarks: <br /> Boring# <br /> I 0-5 On 2.1 1 $ <br /> Ground <br /> elev. <br /> %.0 ft. <br /> Depth to <br /> limiting <br /> factor it <br /> ? 7� <br /> Remarks: �1 <br /> CST Name:—Please Print I�NgRD NoPKI Phone: <br /> Address: Z?-71,0 Nw 35- r R • 54$9-5 <br /> Signature: 9 at�� _ 9y CST Number: <br />