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Wiscors <br /> Labor and Human <br /> Department ooIndustry, SOIL AND SITE EVALUATION REPORT Page_of_ <br /> Labor and Human Relations <br /> Division of Safety a Buildings in accord with ILHR 83.05, Wis.Adm. Code <br /> =00 <br /> Attach complete site plan on paper not less than 8 1/2 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 -15ARCE L I.D.# <br /> dimensioned, north arrow,and location and distance to nearest road. -dLPI—�—� <br /> APPLICANT INFORMATION—PLEASE PRINT ALL INFORMATION REVIEIVED BY DATE <br /> PROPERTY OWNER: / PROPERTY LOCATION lv- a <br /> d/ ®5�i / GOVT.LOT NE 1/4 SW 1/4,S 3 T 38 N,R 17 YE(or)W <br /> PROPERTY 0 V. <br /> MAILING ADDRESS-5�� LOT# BLOCK# SUBD.NAME OR CSM# <br /> CITY,STATE LI CODE PHONE NUMBER <br /> .5W2-2 ( ) -3 9-3'/S�d ❑CITYvE OWN NEAREST ROAD <br /> Daniels <br /> Fosberg Road <br /> [ ] New Construction Use I] Residential/Number of bedrooms 3 [ ] Addition toexisting building <br /> jE] Replacement [ ] Public or commercial describe <br /> Code derived daily How 450 gpd Recommended design loading rate--.7 bed,gpd/ 2 .8 trench,gpd/t2 <br /> Absorption area required 643 bed,ft2 563_trench,ft2 Maximum design loading rate _bed,gpd/ 2 .8 trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s) 94 ft (as referred to site plan benchmark) <br /> Additional design/site considerations NA <br /> Parent material Glacial n ;f Flood plain elevation,if applicable NA ft <br /> S=Suitable for system CONVENTIONAL I MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK <br /> U=Unsuitable for s stem FX]S ❑U FL]S ❑U [IS ❑U b]S ❑U ®S ❑U ❑S .TAI <br /> SOIL DESCRIPTION REPORT <br /> Boring # Horizon Depth Dominant Color Mottles Texture Structure GPD/ft <br /> in. Munsell CU.Sz.Cont.Color Gr. Sz. Sh. Consistence Bourxit y Roots <br /> Bed Trertdt <br /> 433'-84 ' <br /> 6" 7.5 YR 3 2 ------ <br /> 1 S> ---- is lasbk mvfr cs f—co...:::.::<s::a' 23 ' 7.5 YR 4/4 -----� is lmsbk mfr cs f—coGround 7.5 YR 5/6 --------- ms os all 3f 7 8 <br /> elev. -- <br /> 97.4 ft. <br /> Depth to <br /> limiting <br /> factor <br /> >84" <br /> Remarks: <br /> Boring# <br /> n r 1 0-7" 7.5 YR 3/2 ——————— is lmsbk mvfr cs f—co .7 .8 <br /> 2s 2 7"-31 7.5 YR 4/4 -------__ is lmsbk mfr cs f—en .7 .8 <br /> 3 1"-82 7.5 YR 5/6 ------- <br /> Ground ms osg ml 3f 7 8 <br /> elev. <br /> 97 f.. <br /> Depth to <br /> limiting <br /> factor <br /> > 82" <br /> Remarks: co NO <br /> CST Name:—Please Print Wade Rufsholm Phone: <br /> Address: (71 ) 349-7286 <br /> P.O. Box 514 Siren, WI 54872 <br /> Signature: Date: CST Number: <br /> 10/10/95 3583 <br />