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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 a�� <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 J <br /> O L Nl GOVT.LOT N 41 1/4.5 cJ 1/4,S3 a T �y ,N,R / E(or)c_ <br /> PROPERTY OWNER':S MAILING ADDRESS LOT# BLOCK# SUBD.NAME OR CSM# <br /> s y.,� �/a A� e. -So, - <br /> CITY,STATE n ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE ®SOWN NEAREST ROAD <br /> co � b JC /J, �5©i6 iiia) ysY- ��9 a, <br /> [ ] New Construction Use [�,Q Residential/Number of bedrooms --? [ ] Addition to existing building <br /> 14 Replacement [ ] Public or commercial describe <br /> Code derived daily Bow o30 6 gpd Recommended design loading rate <br /> --L-,2 gpd/ft2 trench,gpd/ft2 <br /> Absorption area required %�'9' bed,ft2 �3 75 trench,ft2 Maximum design loading rate . 7 bed,gpd/ft2-z P trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s) 25% ft (as referred to site plan benchmark) <br /> Additional design/site considerations <br /> Parent material G/,9-e-1:4-/ C/ ¢'t Flood plain elevation,if applicable ti.4- ft <br /> S=Suitable for system CONVENTIONAL MOUNDIN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK <br /> U=Unsuitable fors stem ®S ❑U ®S ❑U ®S ❑U [as ❑U aS ❑U ❑S [RU <br /> SOIL DESCRIPTION REPORT <br /> Depth Dominant Color Mottles Structure GPD/ft <br /> Boring # Horizon in. Munsell Qu.Sz.Cont.Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed Tmrich <br /> c-6 ]'S // /S L Jf� c 5 3F-co <br /> _ y <br /> 6 a/ 7-3 r /S in 3- /re d,4 S �Fto P <br /> Ground pm S <br /> elev. <br /> 9�n. <br /> Depth to <br /> limiting <br /> facto '/ <br /> Remarks: <br /> Boring# <br /> "» S 7.Z 7,5 <br /> Ground <br /> elev. <br /> ft. <br /> Depth to <br /> limiting <br /> factor <br /> 7� <br /> qo. <br /> Remarks: <br /> CST Name:-Please Prin� py Phone: <br /> Address: Bo 7� S //' !i✓ t SS�S'7� <br /> Signature: Date: CST Number: <br />