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Wisconsin Department of Indus", SOIL AND SITE EVALUATION REPORT Page_of <br /> Labor and Human Relations <br /> GN ision of Safety&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 <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. 61g 77 n d Soo <br /> APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE <br /> PROPERTY OWNER: PROPERTY LOCATION <br /> T <br /> Otj LECHEKGOVT.LOT.5 1/4 1/4,S 4 T 8 ,N,R 15 E Iw W <br /> PROPERTY OWNER'-S MAILING ADDR S LOT# BLOCK# SUED.NAME OR CSM# <br /> 30 K <br /> CITY,STATE Z CODE PHONE NUMBER ❑CITY []VILLAGE OWN NEAREST ROAD <br /> T• RUL_ 1(o12)�Qo 5306 o E P0 14T l ', <br /> [ j New Construction Use Residential/Number of bedrooms 2 [ j Addition to existing building <br /> Replacement [ J Public or commercial describe <br /> Code derived daily flow 300 gpd Recommended design loading rate .1 bed,gpd/ft2S trench,gpd/ft2 <br /> Absorption area required —bed, ft2 3Z5 trench, 11:2 Maximum design loading rate ._1 bed,gpd/ft2 . 6 trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s) 9G•g ft (as referred to site plan benchmark) <br /> Additional design/site considerations <br /> Parent materialQlgCl'gL 'DRIFT Flood plain elevation, if applicable Nfl ft <br /> S=Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK <br /> U=Unsuitable fors stem EIS ❑U ® S ❑U RIS ❑U ®S ElU ®S ❑U ❑S 2U <br /> SOIL DESCRIPTION REPORT <br /> Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft <br /> in. Munsell Qu.Sz.Cont.Color Gr. Sz. Sh. Bed Trench <br /> .S ,e 3 2 �-- r's. d 1 G5 Zv f . 7 .8 <br /> Z S 57 7.5 R . 7 ! .8 <br /> Ground -7 p5 R y � ;If 5 i /M <br /> elev <br /> W ft. <br /> Depth to <br /> limiting <br /> factor <br /> 57 <br /> Remarks: <br /> Boring# <br /> .7 •8 <br /> Ground`` S?-6q7.S te `l 57/1 S <br /> elev <br /> Depth to <br /> limiting <br /> factor it <br /> -- <br /> Remarks: Aly AA(&' BMA14 <br /> CST Name:—Please Print D , S Phone: 15, 566 J <br /> Address: 2-77 Z5 W155-c506-9 5L/813 <br /> 0 <br /> Signature: < f / Date: CST Number: <br /> wi�t4/41-n- % <br />