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Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page__Zof 3 <br /> Labor and Human Relations <br /> Division of safety a Buildings in accord with ILHR 83.05,Wis.Adm. Code <br /> COU <br /> Attach complete site plan on paper not less than 8 1/2 x 11 inches in size.Plan must include,but . TT <br /> D # <br /> not limited to vertical and horizontal reference point(BM),direction and%of slope,scale or PARCE I.D.# <br /> dimensioned, north arrow,and location and distance to nearest road. <br /> APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEVVED BY DATE <br /> PROPERTY OWNER: PROPERTY LOCATION <br /> A KEORTo IJ GOVT.LOT 1/4 1/4,S T AR E(or)W <br /> PROPERTY OWNERS MAILING ADDRESS� LOT# BLOCK# SUBD.NAME O CSM# <br /> .?03 w <br /> CITY,STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE OWN NEAREST ROAD <br /> oonlE2 f 55L630( (7i5 6.35 7#0B3 -5,-L) <br /> [ ] New Construction Use K Residential/Number of bedrooms Z [ Addition to xisting building <br /> [ ] Replacement [ ] Public or commercial describe <br /> Code derived daily flow,2c)p gpd Recommended design loading rate N/A bed,gpd 2 NJ4 trench,gpd/ft2 <br /> Absorption area required N/A bed,ft2 AA trench,ft2 Maximum design loading rateA2L bed,gpd f�2 A/ trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s) 366 .16re04 5G,r6as4J ?cWft (as referred to site plan benchmark) <br /> Additional design/site considerations_ _5iAbraAg 6yALyh rk)t J ONLY <br /> Parent material G4ACIAL _])Q1f=7- Flood plain elevation,if applicable i AJ/ ft <br /> S=Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE I AT-GRADE SYSTEM IN FILL HOLD�TANKU=Unsuitableforsstem EIS ❑U [IS ❑U EIS ❑U EIS ❑U ❑S ❑U EIS <br /> SOIL DESCRIPTION REPORT <br /> Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistencq Bardary Roots GPD/ft <br /> in. Munsell Qu.Sz.Cont Color Gr. Sz. Sh. Bed Trench <br /> k 32 — (5 lifs ' MV6- CS 3F • 7 .8 <br /> 638 7. SVA /6JC _W mvFr Cw Xr& • 7 •8 <br /> Ground 3S-PI 3,Q /l IFS oipL MFr Cr,J z0ft .3 <br /> elev. <br /> 7502 3114065 MVFr — — . 7 • 8 <br /> Depth to (o" orL 15 Ltaco weir. <br /> limiting <br /> factor ND M01 LtA4- Akn&E0 ,r aB L-.AcroTN. <br /> Remarks: M-G 5oA'6 .xtt 6"? ,,a cWAu-1e R/A*5 ARoAd x V, ,G 4J�1i <br /> Boring# )A) entev of r c`w e . <br /> T F1a�7 13zo L4 .Uo J ca <br /> Ayr o 1.6- w 4 <br /> r 01 <br /> Ci E �UrS JE lS oT sE ( dvwru.? �J/. <br /> tm <br /> Ground <br /> elev. <br /> _ft. <br /> Depth to <br /> limiting <br /> factor <br /> Remarks: <br /> CST Name:—Please Print RAI GoNR�� Phone: 715 259 _69jr <br /> Address: 330 E LAKE AD <br /> Signature: Date: A)if 95 CST Number: 7��D <br />