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Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page of <br /> Labor!ind Human Relations <br /> Division of Safety 8 Buildings in accord with ILHR 83.05,Wis.Adm. Code <br /> COUNTY <br /> Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include,but t+ <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 c-1 �,�+� <br /> J 0 h 'o/\) GrJ GOVT.LOT N 1/4 /uc2.l 1/4,S,,? Tj'/ N,R f E(orll�� <br /> PROPERTY OWNER. MAILING ADDRESS LOT# r <br /> BLOCK# SUED.NAME OR CSM# <br /> ,J <br /> CITY,STAT ZIP CODE PHONE NUMBER [-]CITY [-]VILLAGE MOWN NEAREST ROAD <br /> 56u0ZJ-F- 5Y7y6trn,grs/,/ .0 <br /> [ New Construction Use [ Residential/Number of bedrooms 3 [ ] Addition to existing building -— <br /> j ] Replacement [ j Public or commercial describe <br /> Code derived daily flow 5 O 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/ft2 <br /> Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark) <br /> y <br /> Additional design/site considerations '15r,r <br /> Parent material G /r9 c ;4 / —Flood plain elevation,if applicable' /4- ft <br /> S=Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK <br /> U=Unsuitable for s stem ❑S RU El CSU ❑S flu ❑S XU ❑S aU S ❑U <br /> SOIL DESCRIPTION REPORT <br /> Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft <br /> Boring# Horizon in. Munse <br /> ll Qu.Sz.Cont.Color Gr. Sz. SrEr1Dh <br /> (hh. / Bed T <br /> Ground 3� �k — <br /> elev. <br /> rf�i�ft. <br /> Depth to <br /> limiting <br /> factor <br /> JL <br /> Remarks: <br /> Boring# p _ 7 ', dr <br /> 122 5 <br /> Ground <br /> elev. <br /> 9' / ft. <br /> Depth to <br /> limiting <br /> factor <br /> Remarks: <br /> CST Name:—Please Print Phone: <br /> Address: <br /> Signature: /� Date. CST Number: <br />