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Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page of <br /> Labor and.Human Relations <br /> Division of Safety a Buildings in accord with ILHR 83.05, Wis. Adm. Code <br /> . COUNT <br /> Attach complete site plan on paper not less than 81/2 x 11 inches in size.Plan must include,but RN <br /> OT <br /> not limited to vertical and horizontal reference point(BM),direction and%of slope,scale or PARCH D.7j (� cz <br /> dimensioned, north arrow,and location and distance to nearest road. i� 4 – — <br /> iono <br /> APPLICANT INFORMATION–PLEASE PRINT ALL INFORMATION REVIE ED tYV <br /> k ? DpT ` <br /> PROPERTY OWNER: PROPERTY LOCATION <br /> Q(3E GOVT.LO 1/4 1/4,S T q",R Iq E(or(W) <br /> PROPERTY OWNERS MAILING ADDRESS LOT# BLOCK# SUBD.NAME OF!CSM# <br /> 2.93 Co . RL). R <br /> CITY,STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE XtOWN NEAREST ROAD <br /> 'DARiauR 1. tl�_ <br /> S4%50 &077- <br /> ( ] New Construction Use Residential/Number of bedrooms 7- [ ] Addition to existing building <br /> jA Replacement [ ] Public or commercial describe <br /> Code derived daily Bow 300 gpd Recommended design loading rate .1 bed,gpd/ft�? trench,gpd/ft2 <br /> Absorption area required 429 bed,9 3 75 trench,ft2 Maximum design loading rate bed,gpd/ft2 trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s) Q.S•Z ft (as referred to site plan benchmark) <br /> Additional design/site considerations <br /> Parent material �LACI A L 'DRi FT Flood plain elevation, if applicable A ft <br /> S=Suitable for system �ONVEMIONAL MOUND IN-GROUND PRESSURE AT-GRADE YSTEM IN FILL HOLDING TANK <br /> U=Unsuitable for s stem I S Ell ®S ❑U N'S ❑U .®S ❑U MS ❑U ❑S l$U <br /> SOIL DESCRIPTION REPORT <br /> Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft <br /> in. Munsell Cu.Sz.Cont Color Gr. Sz. Sh. Bed Trends <br /> i I ut`i 1 0-5 fJ ZM .7 .$ <br /> m> a 2. 53to OMS Mt C5 .'7 $ <br /> Ground <br /> elev. <br /> ft. <br /> Depth to <br /> limiting <br /> facIgLf. <br /> Remarks: <br /> Boring# <br /> 1 6-5 '7424K3[Z rte— M3 eHJy µI G 2, I $ <br /> $�L n Z 5-2 s5NIg M5 OH M) -Zm 3 g <br /> ro..._<,,n... <br /> Ground <br /> pellev.� <br /> r-r ft. <br /> Depth to <br /> limiting <br /> factF � <br /> 7 ' <br /> `(t#do <br /> Remarks: <br /> CST Name:—Please Print 916/4,9 O D Phone: �s • 6' S <br /> Address: .27 76l7 W ��7_E 191IS13 <br /> Signature: Date: - qs CSNumber: <br /> r <br />