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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 8 1/2 x 11 inches in size. Plan must include,butE <br /> not limited to vertical and horizontal reference point(BM),direction and%of slope,scale or P RCEL I.D.# <br /> dimensioned,north arrow,and location and distance to nearest road. Oa0-ct3 -n\-&OD <br /> APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE <br /> PROPERTY OWNER: PROPERTY LOCATILN <br /> p FiqFsot4 GOVT.LOT l+2"rlm SE 1/4,8 16 T q0 ,N,R 16 E(or(W) <br /> PRO ERTYOWNER':SMAILINGADDRESS LOT# BLOCK# SUBD.NAME OR CSM# <br /> I Sth *9 VOL 5 P. 2J I <br /> CITY,STATE ZIP CODE PONE NUMBER ❑CITY ❑VILLAGE OWN NFAREST ROAD <br /> MN . 55 ( 73 - rO QAKuqJ higea6D 1K- 90- <br /> N New Construction Use X Residential/Number of bedrooms 3 [ ] Addition to existing building <br /> I ] Replacement [ ] Public or commercial describe <br /> Code derived dairy flow 4S0 gpd Recommended design loading rate • b bed,gpd/ft2--7—trench,gpd/ft2 <br /> Absorption area required_7S bed,ft2 toy 3re'.nchft2 t , Maximum design loading rate .7 bed,gpd/ft2�trench,gpd/ft2 <br /> Recommended infiltration surface elevations) 3 /HGT '19 -14 ft (as referred to site plan benchmark) <br /> Additional design/site considerations ��-- <br /> Parent material G LAGf Al- DRIFT 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 fors stem n S ❑U <br /> 'MS ❑U NS ❑U MS <br /> ElU TRS ❑U ❑S ,4 U <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 Trench <br /> <__'.:;. ] 0-5 7.$ 3 7_ /�� IS M I C 5 w <br /> FL S <br /> Z 5-30 0 y ice— Is 2M k Mfr c 5 rLm .7 .8 <br /> Ground M $ M I t M 7 <br /> I <br /> ft. <br /> Depth to <br /> limiting <br /> f7t Zr <br /> Remarks: <br /> Boring# <br /> 2�:n 7- 6' Z O q `��� I S 7- bK r GS 'Zm -7/q 0 <br /> Ground` M S CI M <br /> el v <br /> �ft. <br /> Depth to <br /> limiting <br /> fact <br /> 7 <br /> Remarks: -t O7 <br /> CST Name:—Please Print &PXIAS Phone: 71s-- S66 IS- <br /> Address <br /> : 2 w EBsrER Wt - 511893 <br /> Signature: Date: CST Number: <br /> - 4 36,70 <br />