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Wisconsin an elationdusoy, SOIL AND SITE EVALUATION REPORT Page�Of� <br /> Labor arR1 Human Relations <br /> Division of safety&Buildings in accord with ILHR 83.05, Wis. Adm. Code <br /> COUNTYR fj/' <br /> Attach'complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include,but `� t Ae ` <br /> not limited to vertical and horizontal reference point(BM),direction and%of slope,scale or PARC L I.D.# <br /> dimensioned, north arrow,and location and distance to nearest road. 0 -So!t cl- 0� too <br /> APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE <br /> TF -O�f <br /> PROPERTY NER: / PROPERTY LOCATION <br /> 4 Qr �/65�/? e fu% • �-r GOVT.LOT 1/4 — 1/4,S 9 T Z11 ,N,R � ',j E(o� <br /> PROP R OWNER': AILI ADDRESS LOT# BLOCK# SUBD NAME SSM# 5 ' <br /> 3 SauRi llir? — — <br /> 7T <br /> ZIPCODE PHONE NUMBER ❑CITY []VILLAGE OW <br /> NEA�E TROAAD <br /> �'ee Lke GUI X68 46 a r/�� liYe <br /> [� New Construction Use Residential/Number of bedrooms [ ] Addition to xisting building <br /> I ] Replacement ( ] Public or commercial describe — <br /> Code derived daily flow .300 gpd Recommended design loading rate •7 bed,gpd/f 2 •8 trench,gpd/ft2 <br /> Absorption area required ,§ bed,ft2 3 73 trench,ft2 Maximum design loading rate • "7 bed,gpd/f 2 •8 trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s) ,9sZ Rep, 9l Sg It (as rr ad to site p an bench"at <br /> Additional design/site consid rations <br /> Parent material ��Q�f'Q y Flood plain elevation,if applicable It <br /> S=Suitable for system CONVENTIONAL I MOUNDIN-GROUND PRESSURE AT-GRADE TEM IN FILL HOLDING T K <br /> U=Unsuitable for s stem lffi S El ®.S ❑U KS El ($[S 1-1U S ❑U El U <br /> SOIL DESCRIPTION REPORT <br /> Texture <br /> Boring # Horizon <br /> Depth Dominant Color Mottles Structure Consistenc, Boundary GPD/ft <br /> in. Munsell Cu.Sz.Cont.Color Gr. Sz. Sh. Roots Bed Trench <br /> 6_1Z la a l — s 3 <br /> ,s s/(o — tndg msd 3f <br /> Ground <br /> elev. — <br /> 9� <br /> Depth to <br /> limiting <br /> factor /r <br /> Remarks: <br /> Boring # p <br /> a- a -Z .7 .0 <br /> Ground <br /> ft. <br /> Depth to <br /> limiting <br /> factor f fl <br /> 7TrT Remarks: <br /> CST Name:—Please Print Phone: <br /> - -KEITH E. STDNt=_R — �-5 5-3'23'2 <br /> Address: A"3= W00D CREEL( RD. <br /> Signature: SIREN, WI 54872 Date: 3CSTNumber: <br />