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Wisconsin Department of 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 81/2 x 11 inches in size.Plan must include,but g <br /> er <br /> not limited to vertical and horizontal reference point(BM),direction and%of slope,scale or PARCEL .D.# <br /> dimensioned, north arrow,and location and distance to nearest road. 016- <br /> APPLICANT <br /> 1 APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED DATE <br /> 7 <br /> PROPERTY OWNER: PROPERTY LOCATInbL- L2 <br /> C R GOVT.LOT 4 SW 1/4,S f T 3q ,N,R /? E( w <br /> PROPE OWNER':SMAILINGADDRESSLOT# BLOCK# <br /> 2--7155- D. 'SOACRES <br /> CI ,STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE WN NEAREST ROAD <br /> srCfz W ( s) 6- 5316 LACOUJ co. RL) FF <br /> New Construcfion Use K Residential/Number of bedrooms ( j Addition to existing building <br /> [ ] Replacement [ ] Public or commercial describe <br /> Code derived daily flow L gpd Recommended design loading rate j•Z bed,gp W 1-Z trench,gpd/ft2 <br /> Absorption area required 37.5 bed,ft2 3 -5 trench,ft2 Maximum design loading rate I•Z bed,gpd/ft2 1• Z- trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s) 9 1•g ft (as referred to site plan benchm k) <br /> Additional design/site considerations <br /> Parent material— (4 LA(J qL -WZ 1�Fj: Flood plain elevation,if applicable It <br /> S=Suitable for system 00NV L ND IN-GROU�!DpRESSURE AT-GRA S 5 IN RLL HOLDINC�TANK <br /> U=Unsuitable for stem ❑S U S ❑U [Is 1�U ❑S �]'U ❑S X2311 <br /> SOIL DESCRIPTION REPORT <br /> Depth Dominant Color Modes Structure GPD/ft <br /> Boring# Horizon in. Munsell Ou,Sz,Cont Color Texture Gr, Sz, Sh. Conssfience Bardry Roots Bed Twxh <br /> r-'� is omss Ml CS ZV ,7 -g <br /> Z /I-34 7.5 49 y /s atis9 MI Cs . 7 .8 <br /> Ground 3 3q-5`I 7•S R 111q C2d 5yK -,'/s /s om-sc, M I Cs 7 8 <br /> n qsH 59 z.s &/0 cel s a 09 c 3 Vfm M-efi" <br /> Depth to <br /> limifing <br /> 3 <br /> (aCtOr 'r <br /> Remarks: <br /> Boring# P <br /> '7-.5\41Z 3 Z LS-9 <br /> I CS zV� <br /> El <br /> Z 39 7.5� 2 ��� /s OMs M I CS .8 <br /> Ground 3 31- 41 7.S R g q C245 R 5 g /S ow M) r-- r— <br /> ,7 • g <br /> elev. <br /> 9L$ft. <br /> Depth to <br /> limifing <br /> factor r. <br /> 317 <br /> Remarks: <br /> T Name:—Please Print / fl� S Phone. <br /> Address: w 3K- WgCfjW)• g <br /> Signature: / r )t, - as I Number: <br />