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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 /> COUN <br /> a m <br /> Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must iTY <br /> nclude,but >zN <br /> RC L I.D.# <br /> not limited to vertical and horizontal reference point(BM),direction and%of slope,scale or PAG# O [ dl <br /> dimensioned, north arrow,and location and distance to nearest road. - <br /> APPLICANT INFORMATION—PLEASE PRINT ALL INFORMATION REVIE NED BY �D TE <br /> PROPERTY OWNER: PROPERTY LOCATION II <br /> GOVT.LOT 1/4 1/4,S Q D T `T 0 ,N,R 14 E(orDw <br /> PROPERTY OWNERS MAILING ADDRESS LOT# BLOCK# D.NAME OR CSM# S} <br /> 9555 KI L�DOD OL. I T. I'I I IAM <br /> CITY STATE ZIPCOD PHONE NUMBER []CITY []VILLAGE OWN NEAREST ROAD <br /> CI 'A K tJ . t`b 1 f7J 43- 9 IWC AO 1-0 - <br /> New <br /> -0 -New Construction Use Residential/Number of bedrooms 2— [ ] Addition tc existing building <br /> [ ] Replacement [ ] Public or commercial describe <br /> Code derived daily flow 300 gpd Recommended design loading rate _bed,gpd1ft2 .8 trench,gpd/ft2 <br /> Absorption area required 29 bed,ft2 375 trench,ft2 Maximum design loading rate •7 bed,g ft2 '8 trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s)10O O ft (as referred to site plan benchmark) <br /> Additional design/site considerations LAKE f 1 . 2. 6 <br /> Parent material �LRCtAL PRIfT Flood plain elevation,if applicable N A It <br /> S=Suitable for systemONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING T NK <br /> U=Unsuitable fors stem S ❑U S ❑U RS ❑U ;4S ❑U S ❑U ❑S 7U <br /> SOIL DESCRIPTION REPORT <br /> Depth Dominant Color Mottles Texture Structure Consistence Boxidary Roots GPD/ft <br /> Boring# Horizon in Munsell Qu.Sz.Cont.Color Gr. Sz. Sh. Bed Trench <br /> ZM .1_ �$ <br /> 6-57 7. <br /> Ground 3 5- 63Sj 4 q1 S R N L MS pMS "'l <br /> elev. <br /> 101_6 It <br /> Depth to <br /> limiting <br /> factor r. <br /> 59 <br /> Remarks: <br /> Boring# OM 5 A-1 <br /> '8 <br /> Mt C3 Z <br /> 1 0-(0 7•S z M5 <br /> � ps ra I ZA1 <br /> M .7 <br /> . OMS <br /> .$ <br /> Ground <br /> gglev. <br /> 1D2.'7ft. <br /> Depth to <br /> limiting <br /> factfor�Q <br /> �¢1 Remarks: <br /> CST Name:—Please Print Phone: <br /> fc y NS �D <br /> Address: Z7 7 60 amg I owl. g'g 3 <br /> Date: CST Number: <br /> Signature: S. 2- 15 <br />