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Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT PageLofs— <br /> Labor an{l Human Relations <br /> 'Division otSafety&Buildings in accord with ILHR 83.05,Wis. Adm. Code <br /> COUNTY <br /> Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include,but �r <br /> not limited to vertical and horizontal reference point(BM),direction and/of slope,scale or PARCEL I.D.# '' II �y <br /> dimensioned, north arrow,and location and distance to nearest road. - �aY—O"I" <br /> APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE <br /> PROPERTY OWNER: PROPERTY LOCATION <br /> THOM" NORDEN S TRO m GOVT.LOT 1 1/4 1/4,S D4 T 4 N,R ' Ejer)W <br /> PROPERTY OWNER':S MAILING ADDRESS Loi# BLOCK# SBD.AIAM--1— , <br /> 15R,30 ;t Cs111 V. l4 P �1 <br /> TY, TATE ZIP CODE PHONE NUMBER ❑CITY []VILLAGE ®TOWN NEAREST ROAD <br /> % S mk) 553'7 .2) y28 2V23 S T-r <br /> lad New Construction Use We Residential/Number of bedrooms 3 [ I Addition to existing building <br /> [ ] Replacement [ ] Public or commercial describe <br /> Code derived daily flow 4 SD gpd Recommended design loading rate bed,gpd/ft2 trench,gpd/ft2 <br /> Absorption area required jb9S bed,112 S(sS trench,ft2 Maximum design loading rate i 7 bed,gpd/ft2_*_S trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s) ' 7 ft (as referred to site plan nchmark) tit tr'bouyAu R4 <br /> Z• Yb k, uCLr Syd <br /> Additional design/slnteconsiderations(trv911�uti��a L�tR4,5 b IZ'XS4' = ��1�,�.'f � ,^�T.� �'"1 <br /> Parent material IT L.*cA*,4-- 'bk. y t Flood plain elevation,if appli le /d,+ fl <br /> S=Suitable for SyStem CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK <br /> U=Unsuitable fors stem RS ❑U 9S ❑U ®.S ❑U 2LS ElU ❑S ORLU ❑S 911 <br /> SOIL DESCRIPTION REPORT <br /> Boring# Horizon Depth Dominant Color Mottles Texture Structure Consistence Baxdary Roots GPD/ft <br /> in. Munsell Cu.Sz.Cont.Color Gr. Sz. Sh. I Bed ITw& <br /> I FSBK IMC?,, C U-) F- ,S <br /> Y" <br /> Ground 3 b- -].S`j(Z S 0 SG- YA L — 10D • 0 <br /> elev <br /> fl. <br /> Depth to <br /> limiting <br /> factor <br /> 1_--94 <br /> Remarks ��'� K�c� <br /> Boring # <br /> L lGsr�,e mF2 W Fa11 . �S <br /> Rei b S D sG L- — — •7 . S <br /> Ground <br /> elev. <br /> Depth to <br /> limiting C <br /> fac r p g <br /> b 1 <br /> Remarks: 3IAjCW&coa� °cit 31-39" SYR L OM B03-TO.�i 13 <br /> CST Name:—Please Print JLLI,gM / -r Ch�s\i rni4N .^ �yPhone: `T <br /> Address: (Z 2 si l'-Cs �4D�JEs I. IC4� , <.L/ ( u <br /> Signature: Date: CST Numb <br /> o>ti, Cf 2 t SS�t cs'Trn. �Ad7 <br />