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Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page of <br /> Labor and Human Belations <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,but <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 /> PROPERTY OWNER: [ PROPERTY LOCATION <br /> ,,T/� e,.5 kd*p--- c9�nJSnit% GOVT.LOT IV61145F1/4,S io T 1/0 ,N,R / 6 E(or6) <br /> PROPERTY OWNER'S MAILING ADDRESS LOT# BLOCK# SUED.NAME OR CSM# ^'�� ��' 0. ,rs <br /> ,,Sc o uS we PL, 7 tarn G'/,>7 Yz' 9/ <br /> CITY,STATE ZIPCODE PHONE NUMBER ❑CITY ❑VILLAGE 0fO07N NEAREST ROAD <br /> ( ] New Construction Use [ ] Residential/Number of bedrooms [ ] Addition to existing building <br /> j ] Replacement [ ] Public or commercial describe <br /> Code derived daily flow — gpd Recommended design loading rate bed,gpd/ft2 — trench,gpd/ft2 <br /> Absorption area required — bed,ft2 — trench,ft2 Maximum design loading rate bed,gpd/ft2 — trench,gpd/112 <br /> Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark) <br /> Additional design/site considerations P r i u v <br /> Parent material G/,wc ,A/ n/i FT Flood plain elevation, if applicable ,v.4 It <br /> S=Suitable for system CONVENTIONAL I MOUND IN-GROUND PRESSURE I AT-GRADESYSTEM IN FILL HOLDING TANK <br /> U=Unsuitable fors stem ❑S ❑U [IS ❑U ❑S ❑U ❑S ❑U ❑S ❑U ❑S ❑U <br /> SOIL DESCRIPTION REPORT <br /> Boring# Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft <br /> in. Munsell CU.Sz.Cont Color Gr. Sz. Sh. Bed Twich <br /> x <br /> Ground j 7 s Y/? <br /> elev. <br /> yLAft. <br /> Depth to <br /> limiting <br /> factor <br /> Remarks: <br /> Boring# <br /> Ground <br /> elev. <br /> ft. <br /> Depth to <br /> limiting <br /> factor <br /> Remarks: <br /> CST Name:—Please Print Phone: <br /> ddr <br /> Signature: Date: CST Number: <br /> /3- Y Ufa 3 <br />