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Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page / of <br /> Labor arid.Human Relations <br /> Division of safety&Buildings in accord with ILHR 83.05,Wis.Adm. Code <br /> COUNT) <br /> Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include,but mo <br /> V,I '" <br /> not limited to vertical and horizontal reference point(BM),direction and%of slope,scale or PARCE D.# <br /> dimensioned, north arrow,and location and distance to nearest road. <br /> APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEDBY �ATE <br /> C�] <br /> PROPERTY OWNER: PROPERTYLOCATI}N ��� O' <br /> IYAR.� / GOVT.LOT^/yV 1/4 N W114, T y/ ,N,R /5 E(or� <br /> PROP RTY5OWNER':SMAILINGADDfiESS / � LQT# iLOCK# SUBD.NAME O CSM# <br /> 5fF/< Da 1 P <br /> CITY,STATE ZIP CODEHONE NUMBER -]CITY []VILLAGE CWOWN NEAREST ROAD <br /> IA*-,f ST� w N ss/i�bia 4D 870 5W/SS E TZ <br /> hn <br /> [ I New Construction Use X Residential/Number of bedrooms [ ] Addition to existing building <br /> K Replacement [ ] Public or commercial describe <br /> Code derived daily flow `Y$O gpd Recommended design loading rate r 7 bed,gpd/ft trench,gpd/ft2 <br /> Absorption area required 6 y3 bed,ft2 56,3 trench,ft2 Maximum design loading rate ' 7 bed,gpd/ft2 trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s) 9S — '6 It (as referred to site plan bench ark) <br /> Additional design/site considerations C-0NV <br /> Parent material G !c< 1" Flood plain elevation,if applicable A1104 ft <br /> S=Suitable for system ONVENTIONAL MssUND IN- ROUND PRESSURE T-GRADE YSTEM IN FILL HOLM TANK <br /> U=Unsuitable for s stem twS ❑U PLS ❑U S ❑U S ❑U ❑S j�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 jTrench <br /> Ground <br /> el <br /> Depth to <br /> limiting <br /> factor <br /> > <br /> Remarks: 'a t <br /> Boring# S M/ q5 <br /> Via........:>:s <br /> 2 aLr) u7V, m l <br /> Ground <br /> <T8�`it. <br /> Depth to <br /> limiting <br /> Remarks: so <br /> CST Name:Please Print a 3✓�-Q. Phone: <br /> Address: oZ5 6 r hJ�' r 'S J LO <br /> Signature: Date: .7-3/ S CST Number: <br />