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Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page_�_of —L <br /> Labor and Human Relations <br /> Division 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 81/2 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 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 /> k/01101 M ' u)'En SD Aj GOVT.LOT 1/4 1/4,S T ,N,R E(or)W <br /> PROPERTY OWNER'S ILING ADDRESS LOT# LOCK SUBD.NAME OR CSM# <br /> 5'srp o S �4_w .sem <br /> C;4,STATE ZIPCODE PHO <br /> NE NUMBER ❑CITY ❑VILLAGE ❑TOWN NEAREST ROAD <br /> % <br /> [ ] New Construction Use I ] Residential/Number of bedrooms [ ) Addition to existing building _ <br /> [ ] Replacement I ] Public or commercial describe <br /> Code derived daily flow 3W gpd Recommended design loading rate bed,gpd/ft2 trench,gpd/n2 <br /> Absorption area required r bed,n2 trench,n2 Maximum design loading rate bed,gpd/n2 trench,gpd/n2 <br /> Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark) <br /> Additional design/site considerations <br /> Parent material 6 Q! Flood plain elevation,if applicable n <br /> S=Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK <br /> U=Unsuitable fors stem ❑S ❑U ❑S ❑U ❑S ❑U ❑S ❑U [ S ❑U ❑S ❑U <br /> SOIL DESCRIPTION REPORT <br /> Boring # Horizon Depth Dominant Color Mottles Texture Structure ConsistenceBoundery Roots GPD/ft <br /> in. Munsell Qu.Sz.Cont.Color Gr. Sz. Sh. Bed Trench <br /> Ej] 42� S-3a 1 --- o5 L c S <br /> Ground 1491 GS <br /> elev. <br /> ft. <br /> Depth to <br /> limiting <br /> factor <br /> Remarks: <br /> Boring # <br /> •\W !C <br /> Q <br /> Ground <br /> elev. <br /> n. <br /> Depth to <br /> limiting <br /> factor <br /> Remarks: <br /> CST Name:—Please Print Phone: <br /> Address: <br /> Signature: Date: C�SI.Number: <br /> 5 <br />