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Wiscpnsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page_Lof .3 <br /> Labor and Human Relations <br /> Division of safety a Buildingsn accord with ILHR 83.05,Wis.Adm. Code <br /> COUNTf <br /> Attach complete site plan on paper not less than 81/2 x 11 inches in size.Plan must include,but $urr/e f t <br /> not limited to vertical and horizontal reference point(BM),direction and%of slope,scale or PARCE I.D.A <br /> dimensioned, north arrow,and location and distance to nearest road. <br /> APPLICANT INFORMATION–PLEASE PRINT ALL INFORMATION REVIE ED BY DATE <br /> !o- a- — <br /> PROPERTY NER: PROPERTY LOCATION <br /> Q or f ✓estneof"CoY GOVT.LOT J' 1/4 , 1/4,S T 38 ,N,R /`f E(or <br /> PROPERTY NE '�SMAILINGADDRESS LOY BLOCK# D AMEO CSM If <br /> ip0• a 3'/r- t7 �— • /'. - 0fSunrl5e 8eacA <br /> ClSTAT ZIPCODE PHONE NUMBER []CITY []VILLAGEOWN NEAREST ROAD <br /> 1'a �f W �� 9 (7/5)e23V-7'143 e✓e Cenj e. (Ji e 1,7 POL <br /> New Construction Use X Residential/Number of bedrooms o2 I ] Addition to existing building ^ <br /> [ ] Replacement I ] Public or oommercial describe �V <br /> Code derived daily flow _3W gpd Recommended design loading rate /i2-bed,gpd 2 A•Z trench,gpd/ft2 <br /> Absorption area required a2-5b bed,ft2 A-TO trench,ft2 Maximum design loading rate gibed,gpd 2 /-aZ trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s) /0/19& It (as referred to site plan bench ark) <br /> Additional design/site considerations o PEA! ;'ei'd S,Y <br /> Parent material ©Y'/ Flood plain elevation,if applicable ft <br /> S=Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK <br /> U=Unsuitable for s stem ❑S ill I [as ❑U ❑S RU ❑S KU ❑S �91J ❑S [til <br /> SOIL DESCRIPTION REPORT <br /> Boring# Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft <br /> le <br /> in. Munsell Qu.Sz.Cont.Calor Gr. Sz. Sh. Bed Tmnch <br /> 5 s/ ��56K ✓ft- C-s -5 <br /> 1�< <br /> 0-9 N , <br /> �� a 9-/9 7 s ip 3 '�� /S �MSL6K m✓{7c- s �� .7 � <br /> Ground 3 /�-aZ 7s ; ✓L� S �M��I h7 M✓7Y GS /f f7� . <br /> 97'I!98 ft. 'f A-c�a 7 S ,('SC in SRS/ 90756/If <br /> mf ^' , a •� <br /> Depth to 7+f&A� <br /> limiting <br /> facto �r <br /> CofARemarks: IF,r aces <br /> Boring # <br /> .. l o-io 7,s / msbK MJ{r cs - <5 .6 <br /> a-i 5 M v s/ �s6k m✓ of .5 •b <br /> Ground 3 n-3 vA <br /> ft. <br /> 3y Vo s s,es e s m rh q <br /> Depth to <br /> -� -75'W s G3 s <br /> limiting 7,SyR b ,L <br /> factore/f , . _ <br /> -'� Remarks: <br /> CST Name:—Please Print Phone: �2 , / <br /> Address: 2322p INOpp CREEK DINERtbs 7 <br /> Signature: ✓ I YVI 04UT2 Date: !� 9/O� CSTZ�7r: <br />