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Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Paof <br /> Labor and Human Relations Page— <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 guigAlcir <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. <br /> APPLICANT INFORMATION–PLEASE PRINT ALL INFORMATION REVIEWED BY DATE <br /> PROPERTY OWNER: PROPERTY LOCATION <br /> GOVT.LOT Se 1/4 1/4,S,%T 41 N,R 6 E(4W) <br /> PROPERTY NER':S MA LING ADDR SS�� LOT# BLOCK# <br /> S7. W 5 <br /> CITY,S E ZIP L;0QE. PHONE NUMBER ❑CITY VILLAGEOW NE RE T ROAD <br /> V ( ) J9 . <br /> [ ] New Construction Use [ ] Residential/Number of bedrooms [ ] Addition to existing building <br /> ] Replacement [ ] Public or commercial describe <br /> AA <br /> Code derived daily flow N4 gpd Recommended design loading rate ---bed,gpd$ �trench,gpd/ft2 <br /> Absorption area required^1�1 bed,ft2 t%� i trench,ft2 Maximum design loading rate bed,gpd/ft2 trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark) <br /> Additional design I site considerations <br /> Parent material gl&141 9 Ir Flood plain elevation, if applicable— 2 ft <br /> S=Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE I AT-GRADESYSTEM IN FILL HOLDING TANK <br /> U=Unsuitable fors stem ❑S ❑U ❑S ❑U El ❑U JEISEIU <br /> osoul o o <br /> SOIL DESCRIPTION REPORT <br /> Boring# Horizon Depth Dominant Color Mottles Texture Structure Consistence Botxldery Roots GPD/ft <br /> in. Munsell Qu.Sz.Cont.Color Gr. Sz. Sh. Bed ITW& <br /> #'..`.,' ' Z (o•`{'L .5 R 4 �— MS O MS Al S 1 8 <br /> pGround 3 iiev Ititl '" g <br /> 1�t ft. <br /> Depth to 14 r <br /> limiting <br /> factor <br /> ? 30 <br /> Remarks: <br /> Boring# <br /> ME <br /> Ground <br /> elev. <br /> ft. <br /> Depth to <br /> limiting <br /> factor <br /> Remarks: <br /> CST Name:—Please Print Q Phone: s• rp66• �S <br /> Address: 23ADO .54O SPM W1 94SV5 <br /> 5 15 <br /> Signature: . / Date: CST Number: <br /> wtuHj <br />