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Wisconsin Department ofIndustry, 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 COU <br /> Attach complete site plan on paper not less than 81/2 x 11 inches in size.Plan must include,but pARCELI.D.# <br /> not limited to vertical and horizontal reference point(BM),direction and%of slope,scale or <br /> dimensioned, north arrow,and location and distance to nearest road. -d - V0 0 <br /> REVIEWED DATE <br /> APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION �,la- <br /> PROPERTY OWNER: PROPERTY LOCATION <br /> GOVT.LOT y 1/4 1/4,S f T ,3 r ,N,R J Y E(or� <br /> PROPERTY 0 NER':S MAILING ADDRESS LOT# BLOCK# SUBD.NAME 0 CSM# <br /> D76 Pe z 4 <br /> CITY,STATE ZIP CODE PHONE NUMBER ❑CITY []VILLAGE ®f OWN NEAREST ROAD of <br /> M�rji S 7 ( ) <br /> [ ] New Construction Use [ ] Residential/Number of bedrooms Z [ ] Addition to xisfing building <br /> D4 Replacement [ ] Public or commercial describe <br /> Code derived daily flow�? o o gpd Recommended design loading rate bed,gpd/ trench,gpd/ft2 <br /> Absorption area required�—bed,ft2�_trench,ft2 Maximum design loading rate bed,gpol 2 trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s) &A It (as referred to site plan bench ark) <br /> Addifional design/site considerations <br /> Parent material_j /a i Q- / �A" </ Flood plain elevation,if applicable It <br /> S=Suitable for system CONVEMIONAL MOUND N-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK <br /> U=Unsuitable for system ❑S WU ❑S BU ❑S ®U ❑S [VU ❑S ®U �S ❑U <br /> SOIL DESCRIPTION REPORT <br /> Depth Dominant Color Mottles Texture Structure Consisten Botndaly Roots GPD/ft <br /> Boring# Horizon in Munsell Qu.Sz.Cont.Color Gr. Sz. Sh. Bed Trench <br /> o- � F <br /> a <br /> Ground y0-6° 7,1 v/G 3 <br /> elev. <br /> Depth to <br /> limiting <br /> factor <br /> H� <br /> ) r use L <br /> ad<s: - <br /> 16 A <br /> Boring # 7 ' , f <br /> s m <br /> Ground <br /> elev. <br /> V,SSft. <br /> Depth to <br /> limiting <br /> factor „ <br /> Remarks: <br /> T Name:-Please PrintI/rt Phone: <br /> 1� G / / f <br /> Address: / o n <br /> Date: CST d <br /> Signature: (� �,,, 77Number. <br /> f- 3SJ C <br />