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Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page of <br /> Labor and Human Relations <br /> Division of safety&Buddurgs ' in accord with ILHR 83.05,Wis.Adm. Code FPRCELI.D.# <br /> Y <br /> J/�� )e <br /> Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include,but not limited to vertical and horizontal reference point(BM),direction and%of slope,scale or7 o�dimensioned, north arrow,and location and distance to nearest road. WED BY �s DA3 9 <br /> APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION cq& <br /> tROPNER: PROPERTY LOCATION <br /> N J e r GOVT.LOTS V4 1/4,$,�J T YO ,N,R�� E(or VI <br /> PITY OWNERS ILING ADpvpRESS LOT# BLOCK# SUBD.NAME OR CSM# <br /> o e.r✓ `/S L K 4-V,ZIP CODE PHONE NUMBER [-]CITY ❑VILLAG '®TOWN NE R`pEST RO D <br /> [ ] New Construction Use rA Residential/Number of bedrooms <br /> a [ ] Addition to existing building <br /> Replacement [ ] Public or commercial describe r <br /> Code derived daily flow GAP gpd Recommended design loading rate bed,gpd/ft2,4trench,gpd/ft2 <br /> 2 ©FJ 57- bed,gpd/ft2�_trench,gpolft2 <br /> Absorption area required �p0 bed,ft trench,ft2 Maximum design loading rate <br /> Recommended infiltration surface elevation(s) �3 Z ft (as referred to site plan benchmark) <br /> Additional design I site considerations — ft <br /> Parent material Cr c i Flood plain elevation,if applicable ti.�+2 <br /> S=Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE YSTEM IN FILL HOLDING TANK <br /> U=Unsuitable for s stem S ❑U 1�S ❑U CSS ❑U as ❑U RS ❑U ❑S ®U <br /> SOIL DESCRIPTION REPORT <br /> Structure Roots GPD/ftre <br /> Depth Dominant Color Mottles Texture Consistence Bounday Bed Trench <br /> Boring# Horizon in Munsell Qu.Sz.Cont.Color Gr. Sz. Sh. <br /> > , 6 <br /> Ground p6 <br /> elev. <br /> Cl <br /> ft. <br /> Depth to <br /> limiting <br /> factor6 <br /> GGr�esa i$�- ec/ tC� ©!I <br /> Remarks: <br /> Boring# 1_51 d <br /> 7 8 <br /> Ground <br /> elev. <br /> Wft. <br /> Depth to <br /> limiting <br /> factor <br /> � d <br /> Remarks: Phone: <br /> CST Name:—Please Print /J 1p� ��a/`,r � ��—'�2 F C <br /> Address: <br /> Date: CST Number: <br /> Signature: � / "�� `` <br />