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WiisconsinDepartment ofIndus", 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 /> CO <br /> Attach complete site plan on paper not less than 81/2 x 11 inches in size.Plan must include,but N �� <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. arm O 3 Vo O <br /> APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIE ED BY DATE <br /> &^ <br /> PRHOPERTYO NER: PROPERTY LOCATION A"I <br /> "1 <br /> '.17.1 N �b GOVT.LOT W 1/4 N E114,S ZT Y ,N,R /46 E(or)O <br /> PROPERTY OWNERS MAIII ( ADD S LOT# BLOCK# SU .NAMED CSM# <br /> S�8 /7S 17 u ;-F / F ,eL) EJT <br /> CITY,STATE ZIP CODE PHONE NUMB�R ❑CITY ❑VILLAGE OWN NEAREST ROAD <br /> �v ,d l✓ ' 55�8� `f 19ts) YB3 -3'1,19 a � 1,)634"111/5;fv,✓ Sf <br /> pQ New Construction Use [k] Residential/Number of bedrooms 3 [ ] Addition to existing building <br /> [ ] Replacement [ ] Public or commercial describe <br /> Code derived daily flow �T6 gpd Recommended design loading rate • 7 bed,gpd/ft G f3' trench,gpd/ft2 <br /> Absorption area required 41 Y3 bed,ft2 543 trench,ft2 Maximum design loading rate ' '7 bed,gpd! - 8 trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s) 9 3. G S ft (as referred to site plannch ark) <br /> Additional design/site considerations �8� c�/tf�n/ l a�Eo7 <br /> Parent material Flood plain elevation,if applicable ft <br /> S=Suitable for system CCOVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK <br /> U=Unsuitable for s stem f�S ❑U ors ❑U 0 S ❑U ®S ❑U S ❑U [us ❑U <br /> SOIL DESCRIPTION REPORT <br /> Boring # Horizon Depth Dominant Color Mottles Texture Structure Consisten Bandary Roots GPD/ft <br /> in. Munsell Qu.Sz.Cont.Color Gr. Sz. Sh. Bed Trertdt <br /> /:.<.::`_< / O-3 i0 /, IS /..,.,Ja4 ✓ as z ., - 7 <br /> �:<><,<� a ado 7.S7,c Y�i� lS /. 3b� v l✓>r" 7 •1' <br /> Ground 3 Z yo 7 S7� J/ <br /> v" S C G� 07 8 <br /> elev. ,315 <br /> /a3 ft "Z 7.5 <br /> Depth to <br /> limiting <br /> factor <br /> 191 <br /> Remarks: <br /> Boring# J O - /O Z/ <br /> �S �im,SbrE <br /> kO. X a zi 7 7� ice' . 7 •8 <br /> Ground <br /> -� z`uz ?.J7�S�a <br /> elev. .85 4C �0 7 S � �/Ce ire.,. �- � S • 7 Q <br /> /oa ft. <br /> Depth to �B8 73 s/lO C.S X_ - 7 ' <br /> limiting <br /> �faa8„ <br /> Remarks: <br /> CST Name:-Please Print C t� L�•��� Phone: 1_T <br /> Address: 16/J- ,260 fh (J L) UC �iLJ y8S..3 <br /> Signature: �� �� / z Date: /9 CS�umbe: <br />