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WiisconsinDepartment ofIndustry, SOIL AND SITE EVALUATION REPORT Page_of_ <br /> Labor and Human Relations <br /> Division bf 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 `pry e_ <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. .2 — 7"/Z g " <br /> APPLICANT INFORMATION—PLEASE PRINT ALL INFORMATION REVIE B DAT9l3�Q� <br /> �N� <br /> PROPERTY WNER: PROPERTYLOCATION <br /> O t0 e r r GOVT.LOT Sr 1/45c 1 1/4,S,.ZB T 410 ,N,R E(or)( L <br /> PROPERTY OWNER':SMAILING ADDRESS LOT# BLOCK# I SUBD.NAME OR CSM# <br /> CITY,STATE / ZIP CODE PHONE NUMBER []CITY ❑VILLAGE ($OWN NEAREST f�0 D <br /> /ge,j Richn,anir/ �F S o (7 6-'.S3/ <br /> /fl�7 as' .jc/ L4K�. Gv, I( , fid <br /> PQ New Construction Use b4 Residential/Number of bedrooms / [ ] Addition to existing building <br /> [ ] Replacement [ ] Public or commercial describe <br /> Code derived daily flow /SG) gpd Recommended design loading rate 7 bed,gpd/ft2 �trench,gpd/112 <br /> Absorption area required��bed,ft2 / SY trench N� imum de gn loading rate Zbed,gpd/n2�trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s) .3 �8•�b ft (as referred to site plan benchmark) / <br /> Additional design/site considerations k—.41?c F m c f /ji v:"U'/ e. ,4s <br /> Parent material G1Ac`f d/`j Flood plain elevation,if applicable ft <br /> S=Suitable for system I CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK <br /> U=Unsuitable fors stem C&S ❑U ®S ❑U ❑S �Zl 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 Qu.Sz.Cont Color Gr. Sz. Sh. Bed Twch <br /> n` <br /> Ground <br /> elev. <br /> ft. <br /> Depth to <br /> limiting <br /> factor <br /> �7? <br /> Remarks: <br /> Boring# <br /> m <br /> o 5 /1, — ✓ <br /> Ground <br /> elev. <br /> Depth to <br /> limiting <br /> factor <br /> 70 <br /> Remarks: <br /> CST Name:—Please Print , Phone: <br /> Address: Qm N 67_/5z s <br /> Signature: Date: CST Number: <br />