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WiisconsinDepartment ofIndustry, SOIL AND SITE EVALUATION REPORT Page of <br /> Labor and Human Relatons <br /> Division of Safety&Buildings in accord with ILHR 83.05,Wis.Adm. Code <br /> COUNTY <br /> I <br /> Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include,but ®"`rnC6C7 <br /> not limited to vertical and horizontal reference point(BM),direction and%of slope,scale or PARCE L I.D.# <br /> dimensioned, north arrow,and location and distance to nearest road. a � <br /> APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIE DATE <br /> PROPE OWNER: PROPERTY LOCATION <br /> zo"ZS6 GOv-r.LOT g $f 041/4 1/4,S _T ,N,R E(e W <br /> PROPERTY OWNERS MAILING ADDRESS LO # BLOCK SUED.NAME CSM# <br /> CITY STATE ZIP CODE PHONE NUMBER _ ❑ ITY ❑VILLAGE N I NEAREST ROAD <br /> New Construction Use pCJ Residential/Number of bedrooms [ ] Addition to Dxisting building <br /> j ] Replacement [ ] Public or commercial describe <br /> Code derived daily flow,3lJ0 gpd Recommended design loading rate ,7 bed,gpd 2(Ztrench,gpd/ft2 <br /> Absorption area required_43U bed,ft2 37�_ trench,ft2 Maximum design loading ratebed,gPdAt2 trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s) 9.� C-3 It (as referred to site plan benchmark) <br /> Additional design/site considerations <br /> Parent material 46Z4&46 Z>e'— - Flood plain elevation, if applicable It <br /> S=Suitable for system CONVENTIONAL I MOUND IN-GROUND PRESSURE I AT-GRADE I SYSTEM INFILL HOLDIN TANK <br /> U=Unsuitable for s stem S ❑U as 11U [IU �- El ❑S ❑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 Trench <br /> r D-3„ 7• fz 3 <br /> S IF61l'l1 Ul'l G 2t�'1 IS/ <br /> Ground 3 -�lg 7, yioz Y/JS O 5 it, K. <br /> elev. (f <br /> ft. <br /> Depth to <br /> limiting <br /> factor <br /> �t 9_4 <br /> - Remarks: <br /> Boring# L S i 6Y�' M` G3 <br /> 1 <br /> . .....:fie <br /> Im <br /> n<:nw <br /> 3 ?,S /Z S1 4S lh12— m GSPrAl , 7 y <br /> Ground <br /> el <br /> ft. <br /> Depth to <br /> limiting <br /> fact r /, _LL <br /> Remarks: L <br /> CST Name:—Please PrintPhone: <br /> Address: a 71 <br /> Signature: h Date: CST Number: <br />