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Wwonsin Department of Indus", 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 <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. fi g- -- �3_)Uo <br /> APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED By, DATE <br /> PROPERTY OWNER: PROPERTY LOCATION ,! <br /> -zoHn I GOVT.LOT I 1/4 1/4,S T N,R 7 E(or W <br /> PROP RTYYOOWWNER':SILINGADDR SS LO # BLOCK# SUB .NAME ORCSM If <br /> 110 Cgsm V. v 2- , C' <br /> TY, ATE ZIP C DE P�ONE NUMBER CITY ❑VILLAGE OWN NE REST ROAD <br /> rt b4 NO. SS ( O¢I -oo�{ wLL Pp. <br /> New Construction Use Residential I Number of bedrooms 3 [ ] Addition to existing building <br /> j ] Replacement [ ] Public or commerdal describe <br /> Code derived daily flow �(,��1 gpd Recommended design loading rate_gibed,gpd/ft2 .g trench,gpd/ft2 <br /> 0 <br /> Absorption area required 3 bed,95(o3 trench 9 Maximum design loading rate •7 bed,gpd/ft2 •$ trench,gpd/112 <br /> Recommended infiltration surface elevation(s) g9.1 ALT ft (as referred to site plan benchmark) <br /> Addifional design/site considerations <br /> Parent material ! hLAOgL 'DRI4rT Flood plain elevation,if applicable AN ft <br /> S=Suitable for system CONVENTIONAL M UND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING T K <br /> U=Unsuitable fors stem S ❑U k S ❑U PdS ❑U OS ❑U 9S ❑U ❑S U <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 ITrionch <br /> Aa 1 D • 5S 32 ��— MS M] CS Z)A 1 $ <br /> DIM <br /> Ground <br /> elev. <br /> $ft. <br /> Depth to <br /> limiting <br /> fact . <br /> Remarks: <br /> Boring # <br /> I 0-S 1-7-54A -3/7, Mf amS MI Cs <br /> a. <br /> Ground <br /> 3 =-&91•S K f � s KI ZM . 1 g <br /> elev <br /> gr,_rQ it. <br /> Depth to <br /> limiting <br /> factor <br /> Remarks: <br /> CST Name:—Please Print IL D�X Phone: 5 _ 0064 <br /> Address: ZT7 to 0 3S ESSrER 1 . S 3 <br /> Signature: WV01 Dat : r CST Number: <br />