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Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page of <br /> Labor and 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 81/2 x 11 inches in size.Plan must include,but �urij" <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. A0-q-3a5-0� — <br /> APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE <br /> 3 I '9-CiLif OWNER: PROPERTY LOCATION <br /> 31ZU�E F KeMA GOVT.LOT 1/4 1/4,S T Ifp ,N,R E(o& <br /> PROPERTY OWNER':S MAILING ADDRESS LOT# BLOCK# SUED.NAME OR CSM# <br /> 211 FKEMST15RI7 a- Pp . 131 ( CAKLIAr,0 SdOKCS <br /> CITY,STATE ZIP CODE PHONE NUMBER OCITY ❑VILLAGE OWN NEAREST ROAD <br /> N S ( f5 ) C- N9b6 0 KHAN FRE 5_r6A <br /> [ ] New Construction Use W Residential/Number of bedrooms 3 [ ] Addition to existing building <br /> Replacement [ ] Public or commercial describe <br /> Code derived daily flow LISD gpd Recommended design loading rate bed,gpd/ft2 •$ trench,gpd/ft2 <br /> Absorption area required W bed,ft2 51e3 trench,ft2 Maximum design loading rate bed,gpd/ft2 trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s) QS•5 ft (as referred to site plan benchmark) <br /> Additional design I site considerations <br /> Parent material GLAC I p t- 'D R I f T Flood plain elevation, if applicable Alh ft <br /> S=Suitable for system ' <br /> NVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE S STEM IN FILL HOLDING TANK <br /> U=Unsuitable fors stem S ❑U fS [3U -OS ❑U S ❑U S ❑U ❑S ZU <br /> SOIL DESCRIPTION REPORT <br /> Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft <br /> Boring# Horizon in. Munsell Qu.Sz.Cont.Color Gr. Sz. Sh. Bed Trench <br /> n bk My <br /> a 2 6 H s 2 � v �— Is lnbk Mufr cS <br /> Ground 3 7.75 7•S A 4 q r MJ tib e, rel <br /> elev. <br /> 7.8 ft. <br /> Depth to <br /> limiting <br /> fact <br /> > is <br /> Remarks: <br /> Boring # -7 9 <br /> 2- 1 � a 4 7 q-?Z ?•S -' � �1 I^f bK Mv�Y 8 <br /> C�t:3\f`;wy <br /> Ground <br /> elev. <br /> 9.6 ft. <br /> Depth to <br /> limiting <br /> factor <br /> > Z <br /> Remarks: QIa 6,4.60 <br /> CST Name:—Please Print Phone: <br /> ,c�A�ev yo>oK„�s SG6- is <br /> Address: 2-77/00w 35 WE135715R W/. S`/ 813 <br /> Signature: ,I Date: CST Number: <br /> ft I • `� 34-7a <br />