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Wisconsin Department of Indus", SOIL AND SITE EVALUATION REPORT Page / of 7 <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,but u E <br /> not limited to vertical and horizontal reference point(BM),direction and%of slope,scale or PA CEL 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 WNFA / PROPERTY LOCATION prc <br /> *' <br /> cl eL,61� '_ �+O a ir-7 G6YF.EGT So va Su)11 ,SR3 T 38 ,N,R / E(or W <br /> PROPERTY 3a�RO:S MAILING ADDRESS CYee l� r\6a�Q LOT# BLOCK SUBD.NAM OR CSM# A_ <br /> CITY,STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE grOWN NEAREST ROAD <br /> S 'rev. uJZ S P 17i5i 53- -23a Dah,'e1S a Sao tJoalGreK Pc% <br /> [ I New Construction Use [—] Residential/Number of bedrooms [ J Addition to existing building <br /> �*Replacement [ ] Public or commercial describe — <br /> Code derived daily How — gpd Recommended design loading rate — bed,g /ft2 — trench,gpd/ft2 <br /> Absorption area required bed,ft2 _ trench,f 2 Maximum design loading rate bed,g /ft2 — trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s) Lowes/ ft (as referred to site plan benchmark) <br /> Additional design/site considerationstri✓ ohf"n <br /> Parent material &Iau'a( b-, Flood plain elevation,if applicable A14- ft <br /> S=Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK <br /> U=Unsuitable fors stem ERS <br /> ❑U WS ❑U ®S ❑U BS ❑U ES ❑U ❑S .-RU <br /> SOIL DESCRIPTION REPORT <br /> Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bal Roots GPD/ft <br /> in. Munsell Qu.Sz.Cont.Color Gr. Sz. Sh. Bed Trench <br /> i. :. :`:a <br /> a`. k3 A5 ms my cs f -7 .P <br /> l a- 7•s / 6K <br /> a -7 s "� is iMSz k- vs r-c4 .-7 . <br /> Ground 3 -au 7 P �� S p S rn T rn .cP <br /> el <br /> "t. <br /> Depth to <br /> limiting <br /> factor n <br /> 7 <br /> Remarks: <br /> Boring # <br /> Fhb........fr' <br /> Ground <br /> elev. <br /> n. <br /> Depth to <br /> limiting <br /> factor <br /> Remarks: <br /> CST Name:—Please Print B� Oiye1^ Phone: 7� <br /> ds3- aaa <br /> Address: d3o?ao Wcod Gree.K Rd. =S v 97g <br /> Signature: Date: 1?/W9 CST Number: <br />