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sconsin <br /> nt of <br /> Libor and Human elationdusvy, SOIL AND SITE EVALUATION REPORT Pae _ <br /> Labor and Human Relations g _Of <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 L&A der <br /> not limited to vertical and horizontal reference point(BM),direction and%of slope, scale or PARCEL I D.# <br /> dimensioned, north arrow,and location and distance to nearest road. ckg y[Oct- 0,-'bO <br /> APPLICANT INFORMATION—PLEASE PRINT ALL INFORMATION REVIEWS BY CDATE <br /> PROPERTY OWNER: PROPERTY LOCATION <br /> CHUCKUSTRF50JJ GOVT.LOT21 \1/4 114,S9 T y0 ,N,R /y E(o W <br /> PR ERTYOWNE '�SMAILINGADDRESS LOT# BL CK SUBD.NAMEOR M# <br /> 595 .�I I <br /> L-0 TIZ . G9+ 1075 <br /> CITY,STATE ZIP CODE PyyONE NUMBER ❑CITY ❑VILLAGE DOWN NEAREST ROAD <br /> IWITAGE 0 E Mrjc b12)If59 - l z o A K07_J9 <br /> [ ] New Construction Use Residential/Number of bedrooms ] ] Addition to exi ting building <br /> Replacement [ ] Public or commercial describe <br /> Code derived daily flow300 gpd Recommended design loading rate .7 bed,gpd/ft2 • $ trench,gpd/112 <br /> � <br /> Absorption area required Zq bed,ft2 375 trench,ft2 Maximum design loading rate _bed,gpd/ft2 • S trench,gpd/ft2 <br /> Recommended infiltrafion surface elevation(s) 114 ft (as referred to site plan benchmark) <br /> Additional design/site considerations <br /> Parent material_4LAe1f}(_ QQtf-T Flood plain elevation,if applicable it <br /> S=Suitable for system CONVENTIONAL MOUND IN- ROUND PRESSURE AT-GRADE SY TEM IN FILL HOLDING T K <br /> U=Unsuitable fors stem hY S ❑U X S ❑U S El 9 S El S ❑U ❑S <br /> SOIL DESCRIPTION REPORT <br /> Boring# Horizon Depth Dominant Color Mottles Texture Structure ConsistenceRoots GPD/ft <br /> in. Munsell Cu.Sz.Cont Color Gr. Sz. Sh. lbxxlaBed Trerkh <br /> IS IN—,6,k MI C-5 7 <br /> 5-58 A Al'o CS Zi . 7 • 8 <br /> Ground 3 8.62 7. x <br /> elev. <br /> ft. <br /> Depth to <br /> limiting <br /> factor •� <br /> Remarks: <br /> Boring# <br /> ` u 1 0-5 -7s A 44 I C5 ZM 7 g <br /> tis r <br /> •8 <br /> Ground <br /> elev. <br />/022-0 ft. <br /> Depth to <br /> limiting <br /> fact <br /> Remarks: <br /> ig <br /> CST Name:—Please Print fLl'��Rp I'OI�S Phone: IS• �- IS <br /> ddress: O W E85'f�R W1 . Sy893 <br /> Signature: . / Date: CST Number: <br /> ut1R��A - l0 34970 <br />