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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 /> COU <br /> Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include,but �S�Q <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. -0I- <br /> APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BR n —DAI� <br /> y_ <br /> PROPERTY OWNERp: PROPERTY LOCATION <br /> Op <br /> /) o A.> PAfo/✓.+tJ GOVT.LOT /J8'1/4 S c 1/4,S'36/ 7 y/ ,N,R 14 E(or) } <br /> PROPERTY OWNER'S MAILING ADDRESS LOT# BLOCK# SUED.NAMEOR CSM# <br /> CITY,STATE ZIP CODE PHONE NUMBER LICITY ❑VILLAGE MOWN NEAREST ROAD <br /> QA/V6vr 3 c> ( ) S wi 5 S 241 <br /> [yQ New Construction Use pct Residential/Number of bedrooms 2 [ ] Addition toexisting building — <br /> [ ] Replacement [ ] Public or commercial describe <br /> Code derived daily flow gpd Recommended design loading rate t 7 bed,gpd/ 2_ , ? trench,gpd/ft2 <br /> Absorption area required ya� bed,ft2 3 7�trench,ft2 Maximum design loading rate , -2 bed,gpd/ 2 , .9 trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s) qS% ? It (as referred to site plan benchmark) <br /> Additional design/site considerations <br /> Parent material G 14<i A Flood plain elevation, if applicable /} It <br /> S=Suitable for system CONVENTIONAL I MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK <br /> U=Unsuitable fors stem ❑U as ❑U 29 S ❑U aS ❑U [A S ❑U ❑S N U <br /> SOIL DESCRIPTION REPORT <br /> Boring # Horizon Depth Dominant Color Mottles Texture Structure ConsistenceBoundary Roots GPD/ft <br /> in. Munsell Cu.Sz.Cont.Color Gr. Sz. Sh. Bed Trench <br /> 75 /p3/z <br /> Ground <br /> elev. <br /> 97.'9ft. <br /> Depth to <br /> limiting <br /> factor <br /> 78y <br /> Remarks: <br /> Boring# <br /> <',< <br /> P31.2 (r CS 3 -c- <br /> Ground <br /> elev. <br /> 97,3 It. <br /> Depth to <br /> limiting <br /> factor <br /> X76 <br /> Remarks: '1 <br /> CST Name:—Please Printer �QyISXo/m Phone: <br /> 'I <br /> Address: Po '0 6'y S/ s;ra.0 4" <br /> Signature: L J Date: CST Number: <br />