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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 l-ve.1�4 <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. 15z"Y z 2— �I y <br /> APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY �a DATE <br /> /Q <br /> PROPERTY OWNER: PROPERTY LOCATION <br /> ,tj,�j GOVT.LOT ,j'� 1/4/jfC_-1/4,S,2,QT VO ,N,R i5 E(or W <br /> PROPERTY OWNERS MAILING ADDRESS LOT.# BLOCK# SUBD.NAME OR CSM# <br /> J C7 a/ ,rJIdYS Zue., <br /> CITY,STATE ZIP CODE PHONE NUMBER ❑CITY []VILLAGE GOWN NEAREST ROAD <br /> ej <br /> [ ] New Construction Use jk]' Residential/Number of bedrooms [ ] Addition to existing building <br /> Dy.Replacement [ ] Public or commercial describe <br /> Code derived daily flow,70 rJ gpd Recommended design loading rate 7 bed,gpd/ft2 , trench,gpd/ft2 <br /> Absorption area required /bed,ft2 ,�7Strench,ft2 Maximum design loading rate gibed,gpd/tt2 trench,gpd/(t2 <br /> Recommended infiltration surface elevation(s) 9� e ft (as referred to site plan benchmark) <br /> Additional design/site considerations <br /> Parent material r3 zi!2:e-z;4/ -J - ,,e_ t Flood plain elevation, if applicable ti� ft <br /> S=Suitable for system CONVENTIONAL MOUNDIN-GROUND PRESSURE XT-GRADE SYSTEM IN FILL HOLDING TANK <br /> U=Unsuitable for s stem [KS ❑U as ❑U I 9LS ❑U S ❑ ❑S RU <br /> SOIL DESCRIPTION REPORT <br /> Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft <br /> n. Munsell Qu.Sz.Cont Color Gr. Sz. Sh. Bed Tmnch <br /> " g <br /> O-5 , <br /> Soo <br /> Ground 3 �Y ,s 1f S <br /> elev. <br /> Depth to <br /> limiting <br /> factor <br /> LL <br /> Remarks: <br /> Boring# <br /> <sa3' - 7.� /S K J r c F <br /> Ground 7,5- 5, 71rt' <br /> elev. <br /> �ft. <br /> Depth to <br /> limiting <br /> factor r� <br /> Remarks: <br /> CST Name:—Please Print / Phone: <br /> t v SSL, e <br /> Address:QoXS� S .���✓ cam✓ 5i87a <br /> Signature: Date: CSSNumber: <br /> S <br />