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of <br /> Labor ndHu an Rel tions 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 8 1/2 x 11 inches in size. Plan must include,but UMkTr <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. �e� 5����—dl/ 6_0 0 <br /> APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVII ZDATE <br /> PROPERTY OWNER: PROPERTY LOC T ON r �3 <br /> LL Eie GOVT.LOT 0 1/4 1'1/4,S I►} T ,N,R E(or W <br /> PROPER �AMIE GADDRESS LOT# BLOCK# <br /> lal Z—ikIP CODE -PHONE NUMBER "W CRS <br /> ( 5)��5-7 ❑CITY ❑VILLAGE ]gJrOWN NEAREST ROAD <br /> n!E LxRa. <br /> [ I New Construction Use Residential Residential/Number of bedrooms Additio to existing building <br /> PQ Replacement I I Public or commercial describe <br /> Code derived daily flow 9Pd Recommended design oading rate .7 2 2 <br /> gl�ft g trench,gpd/ft <br /> Absorption area required (eq3 bed,ft2 S63 trench,ft2 Maximum deli n loadin rate 2 , $ 2 <br /> g g 9Pd/ft trench,gpd/ft <br /> Recommended infiltration surface elevation(s) 6-Z ft (as referred to site plan benchmark) <br /> Additional design/site considerations 10 ,c (a5 pF <br /> Parent material GLAC104L 'ggjET- <br /> Flood plain elevation, if applicable Np ft <br /> S=Suitable for system CONVENTIONAL (�UND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING T NK <br /> U=Unsuitable fors stem S ❑U S ❑U S ❑U ®S ❑U V1 S ❑U ❑S I�U <br /> SOIL DESCRIPTION REPORT <br /> Boring# Horizon Depth Dominant Color Mottles Structure <br /> in. Munsell Qu.Sz.Cont.Color Texture Consistence Bamciary Roots GPD/ft <br /> Gr. Sz. Sh. Bed Trerich <br /> Cis <br /> dI Cs M .1, 8 <br /> eev <br /> elev. <br /> 5 R q uip- SI <br /> M r <br /> �$ft. <br /> Depth to <br /> limiting <br /> factor.. <br /> Remarks: <br /> Boring# <br /> Ms d c <br /> dl jr, 3 s <br /> Ground 66 �g SI Mb14 6 <br /> elev. <br /> 11.1 ft. <br /> Depth to <br /> limiting <br /> fact r$ <br /> Remarks: <br /> CST Name.—Please Print <br /> 90 P i 14'sPhone: <br /> S )S- 866- /S b <br /> Phone- <br /> Ad-dress Z`T 60 w 3S �BsTER Wi. S`{gq� <br /> Signature: •f Date: <br /> - - R 6 �T Number: <br />