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Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Pageof <br /> Labor and Human Relations <br /> Divisibn of Safety 8 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 BUAdglfr <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. ;10 "713 <br /> — /3/5 — 0 <br /> APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED DATE <br /> PROPERTY OWNER: PROPERTY LOCATION <br /> GOVT.LOT 1�•I 1/4 �E: 1/4,S 15 T q0 ,N,R. E(ore <br /> PROPER OWNER':SMAILINGADDRESS LOT# BLOCK# <br /> 5j5r46n1XD- <br /> CITY,STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE OWN N RST ROAD <br /> AAI 1n11. `� ( ) OR Lp n En�5EN RD. <br /> [ ] New Construction Use pQ Residential/Number of bedrooms 3 [ ] Addition to existing building <br /> C< Replacement [ ] Public or commercial describe <br /> Code derived daily flow 4sb gpd Recommended design loading rate . 1 bed,gpd/ft2$trench,gpd/ft2 <br /> Absorption area required U+3 bed,112 5/o3 trench,112 Maximum design loading rate --1 bed,gpd/ft2.Strench,gpd/ft2 <br /> Recommended infiltration surface elevation(s) q q. 2 ft (as referred to site plan benchmark) <br /> Additional design/site considerations <br /> Parent material CILACI iiL DRIFT Flood plain elevation,if applicable //A ft <br /> S=Suitable for system CONVENTIONAL I M UND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK <br /> U=Unsuitable fors stem t�S ❑U S ❑U Sou K, ❑U 5nS ❑U ❑S ($U <br /> SOIL DESCRIPTION REPORT <br /> Depth Dominant Color Mottles Structure GPD/ft <br /> Boring # Horizon Texture Consistence Boundary Roots <br /> In. Munsell Qu.Sz.Cont Color Gr. Sz. Sh. Bed Trench <br /> •8 7 57 YR, 3/z: ✓� �� /S 0M3 l S 2✓F .7 . 8 <br /> x : 2 8 15 �•S rt y y /tom /s QM AAs �— 7 8 <br /> Ground 3 IS-49 StIR y .� Ms>✓ r y M.�r 5 �— .7 .8 <br /> elev. <br /> I&S-ft. y 68 9 7s VX q y 5 OA M1 '" 7 •8 <br /> Depth to <br /> limiting <br /> fact <br /> 7 <br /> Remarks: All RaqlAtS 4A f7-dt/ /S / A/DS <br /> Boring# <br /> 0- 5 � 13M di 7 8 <br /> .:. .. <br /> Ground <br /> elev. 65 83 X `� S Am-e4 M 1 n .7 <br /> 8 <br /> Qt ft. <br /> Depth to <br /> limiting <br /> factor <br /> t <br /> Remarks: <br /> CST Name:—Please Print 1 mig D Phone: /S- 866- /,5 <br /> Address: 2--7-76q Nw —aS Q6&5r6je Q1. —51S —S <br /> Signature: Date: CST Number: <br /> u�iRtd 3 - 0 <br />