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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 81/2 x 11 inches in size. Plan must include,but 1511 <br /> not limited to vertical and horizontal reference point(BM),direction and%of slope,scale or PAR EL I.D.# <br /> dimensioned, north arrow, and location and distance to nearest road. -po Ac O"l- <br /> APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BtDATE <br /> / ?I a <br /> PROPERTY OWNER: PROPERTY LOCATION <br /> uS GOVT.LOT 1/4 1/4, 2 T ,N,R 15' E(o� <br /> PROPERTY OWNER'S MAILING ADDRESS LOT# BLOCK# SUBD.NAME OR CSM# <br /> Z'76114-5 f- <br /> CITY,STATE ZIP CODE P ONE NUMBER []CITY []VILLAGE OWN NEAREST ROAD <br /> Sfg5f'993 c 15)$6 - g 2 CKSoN SANQ D- <br /> [ ] New Construction Use D< Residential/Number of bedrooms Z [ ] Addition to existing building <br /> K Replacement [ ] Public or commercial describe <br /> Code derived daily flow 300 gpd Recommended design loading rate bed,g M2 •8 trench,gpd/112 <br /> Absorption area required 2-a bed,ft2 37S trench,112 Maximum design loading rate 7 bed,g /ft2 •8 trench,gpd/112 <br /> Recommended infiltration surface elevation(s) qs•2 ft (as referred to site plan benchmark) <br /> Additional design/site considerations <br /> Parent material G LR CI f=11- 'DRI Pr Flood plain elevation,if applicab a AIA ft <br /> S=Suitable for system NVENTIONAL I MOUND IN,GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK <br /> Ito is stem S ❑U ®S ❑U ®S ❑U RIS ❑U ®S ❑U ❑S JOU <br /> SOIL DESCRIPTION REPORT <br /> Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft <br /> _ in. Munsell Qu.Sz.Cont Color Gr. Sz. Sh. Bed Trenclh <br /> 14�a 1 S 7 -7 . $ <br /> �J IS 01t1S Wt I ZM 3 S <br /> Ground <br /> elev. <br /> qtr•$ it. <br /> Depth to <br /> limiting <br /> factor <br /> Remarks: <br /> Boring# <br /> 7-519 -3/ �5 OM5 M1 CS Zrt • 7 .� <br /> 2 s 2 - 71� 7.549, 1S OMS M I Zi I 1 8 <br /> Ground <br /> elev. <br /> $R-A ft. <br /> Depth to <br /> limiting <br /> 22o -r <br /> L L=7 <br /> Remarks: <br /> TName:—Please PrintdGHR9D OvKJ,f Phone: s 866_ /1�� <br /> dress: 27 /v0 w 35/V b,/�BS? 12 W�• Sy893 7 <br /> Signature: •/ _ Date: CST Number: <br /> INLI•M.OI p- /Z 3670 <br />