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WiisconsinDepartment oflndusby, 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 81/2 x 11 inches in size. Plan must include,but <br /> not limited to vertical and horizontal reference point(BM),direction and%of slope,scale or PARCEL I.D.If <br /> dimensioned, north arrow,and location and distance to nearest road. Dd 8-- _?//8- O-L 3/ZZ <br /> APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWEDBY,/, DATES <br /> PROPERTYOWNER: // PROPERTY LOCATION r <br /> ,4r y/ T <br /> d N iJS on l GOV .LOT y �v4-1/4 ry N'"1/4,S/g T 38 ,N,R /�j E(or� <br /> PROPERTY_0 ER':S MAILING ADDRESS LOT* BLOCK# SUBD.NAME OR CSM# <br /> �D.S fir r;,e-t E , .S — — <br /> CITY,STATE ZIP CODE PHONE NUMBER ❑CITY []VILLAGE ®FOWN NEAREST ROAD <br /> [*New Construction Use [XJ Residential/Number of bedrooms [ ] Addition to existing building <br /> I ] Replacement [ ] Public or commercial describe <br /> Code derived daily flow ero gpd Recommended design loading rate 7 bed,gpd/ft2 .8 trench,gpd/ft2 <br /> Absorption area required q bed,ft2 7s trench,ft2 Maximum design loading rate , 7 bed,gpd/ft2 oo trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s) 9S"% 2 ,41Q =M< f 791 y ft (as referred to site plan benchmark) <br /> Additional design/site considerations — <br /> Parent material G/,ac,:v/ Flood plain elevation,if applicable ft <br /> S=Suitable for system CO VENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK <br /> U=Unsuitable for s stem S ❑U ($S ❑U CSS ❑U fs�S ❑U 15 .5 ❑U ❑S ZU <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 BoulLsuy Roots Bed Trendl <br /> R. <br /> reroa as �,s � iy — /s I�S6K 5S pro d' <br /> Ground ;t5`79 7,Sy71 _�;e' — -5 12 ,9 <br /> elev. <br /> 519,3 ft. <br /> Depth to <br /> limiting <br /> factor <br /> 778 <br /> Remarks: <br /> Boring# <br /> 7,57/ <br /> Ground <br /> elev. <br /> v[ft. <br /> Depth to <br /> limiting <br /> factor <br /> 776 <br /> Remarks: <br /> CST Name.—Please PrinPhone: <br /> Address: <br /> Signature: Date: CST Number: <br /> G✓a� - - 3G -3s,93 <br />