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Viloonsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page_of_ <br /> Labor and Human Relations <br /> Division of 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 <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. _5 ( 510 7j'-_ c' -2 <br /> APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY RATE 9� <br /> PROPERTY OWNER: PROPERTY LOCATION <br /> /_ /,e 5 Gcf���� j- GOVT.LOT 1/4 1/4,S 31/T 37 ,N,R/f' E( <br /> PROPERTY OWNER'S MAILING ADDRESS LOT# BLOCK# SUBD.NAMEORCSM# <br /> a 0c r /�� / �7 PlAt r ` S r/%150 u /6Pizr <br /> CITY,ST TE ZIP CODE PHONE NUMBER ❑CITY []VILLAGE Eff OWN NEAREST ROAD / <br /> ( ] New Construction Use [X Residential/Number of bedrooms [ ] Addition to existing building -- <br /> [>Q Replacement [ ] Public or oommercial describe <br /> Code derived daily flow 011 gpd Recommended design loading rate — bed,gpd/ft2 — trench,gpd/ft2 <br /> Absorption area required — bed,112 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 /> Additional design I site considerations /t ro e- '4/amu �e S,v s 24, <br /> Parent material C/,r c �L J_ c4l�= 'E t Flood plain elevation,if applicable /,L/ 4- ft <br /> S=Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE I SYSTEM IN FILL HOLDING TANK <br /> U=Unsuitable fors stem ❑S ICU ❑S ®U 11S [RU ❑S EZU ❑S I U ES ❑U <br /> SOIL DESCRIPTION REPORT <br /> Depth Dominant Color Motdw <br /> Mottles Texture Structure Consistence Botny Roots GPD/ft <br /> Boring# Horizon in. Munsell Qu.Sz.Cont.Color Gr. Sz. Sh. Bed 7T2nd1 <br /> Ground <br /> elev. <br /> ft. <br /> Depth to <br /> limiting <br /> factor <br /> Remarks: <br /> Boring # <br /> @T:mn�:h'g3 <br /> L <br /> Ground <br /> elev. <br /> ft. <br /> Depth to <br /> limiting <br /> factor <br /> Remarks: <br /> CST Name:—Please Print Phone: — <br /> Address: �.j <br /> Signature: // to: <br /> ,CST Number: <br />