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WiisconsinDepartment ofIndus", 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 /> COUNTYR �I <br /> Attach complete site plan on paper not less than 8 1/2 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.# <br /> dimensioned, north arrow,and location and distance to nearest road. , <br /> APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIDA EDB ;ATEG( <br /> PROPERh/} 701,WNER: PROPERTY LOCATION e ` <br /> / f)'''"')io Sg e �— ABOVP.teT- AI 1/4 Wt-J1/4,S Z T yd ,N,R /5'- E(or)� <br /> PROP RTY OWNER':S MAILI ADDRE LOT* BLOCK# SUBD.NAME 0 CSM# <br /> O A 0 X5- e/ <br /> V, <br /> STATE ZIP CODE PHONE NUM R []CITY []VILLAGE ®TOWN NEAREST_WAP <br /> rf cc/ 5y3YS (�/jT ���-`1S9/ TAGICSo J Co, 11c/ <br /> [ ] New Construction Use Residential/Number of bedrooms o3 [ J Addition to xisting building - <br /> A Replacement [ ] Public or commercial describe - <br /> Code derived daily flow ySZ� gpd Recommended design loading rate 7 bed,gpd/ft2 trench,gpd/ft2 <br /> Absorption area required 6Y.3 bed, 112 �3 trench,ft2 Maximum design loading rate bed,gpd 2 , 8 trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark) <br /> Additional design/site considerations _ <br /> Parent material G /A-C ;,g-/ !2 r:FT Flood plain elevation, if applicable s9 It <br /> S=Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADESYSTEM IN FILL HOLDING TgNK <br /> U=Unsuitable for s stem 0S ❑U ENS ❑U as ❑U IgS [IU JS S ❑U ❑S IdRJ <br /> SOIL DESCRIPTION REPORT <br /> Boring Horizon Depth Dominant Color Mottles Texture Structure Consisten Boundary Roots GPD/ft <br /> in. Munsell Qu.Sz.Cont.Color Gr. Sz. Sh. Bed Trerch <br /> £ % / O S 7'`'`1'/P3�.z_ �^ //t7S '\ /�jVFe G5 3{-Co , <br /> Ground /'/°S 7, 7 y� in S GtiS /1'I / -co , <br /> elev. <br /> 98. /ft. <br /> Depth to <br /> limiting <br /> factor <br /> Remarks: <br /> Boring # p 3� 7 <br /> a a 6-as <br /> *7,57'f Y/ _ / s �, K r,crr`� j s 3f-1- <br /> as-)6 OS Ct <br /> Ground <br /> elev. <br /> 7Z ft <br /> Depth to <br /> limiting <br /> factor 6k <br /> Remarks: <br /> CST Name:-Please Print /G /�y�S /o/M Phone: <br /> Address: f'p QoX S/ „ 5/mil �nJ d✓ S' �7� <br /> Signature:, Date: CST Number: <br />