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Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page of <br /> Labor aAd Human Relations <br /> -Division of Safety&Buildings in accord with ILHR 83.05,Wis.Adm. Code <br /> couNrr <br /> Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include,but B R N <br /> lqT <br /> not limited to vertical and horizontal reference point(BM),direction and%of slope,scale or PARCE I.D.# <br /> dimensioned, north arrow,and location and distance to nearest road. - <br /> APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIE ED BY M�kDATE <br /> PROPERTY OWNER: PROPERTY LOCATION �/ <br /> � Ly- - Lo 1) AIL-t- MI K GOVT.LOT I d 1/4 1/4,S T -7o ,N,R (o E(or OW <br /> PROPERTYOWNER':SMAILING ADDRESS LOT If BLOCK# SUBD.NAME O CSM# <br /> t" ST. <br /> CITY,STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE OWN NEAREST ROAD <br /> I . 5 0 ( U 3133 cc PO <br /> New Construction Use Residential/Number of bedrooms ) [ ] Addition to existing building <br /> �Q Replacement [ ] Public or commercial describe <br /> Code derived daily flow 1_50 gpd Recommended design loading rate bed,gpd 2 •00 trench,gpd/ft2 <br /> Absorption area required 415- bed,tt2�_trench,ft2 Maximum design loading rate� tx_ ed,gpd/ 2 '00 trench,gpd/ft2 <br /> 57 infilVation surface elevation(s) 92- - 1 ft (as referred to site plan bench ark) <br /> Additional design/site considerations 56FUtJG -To 1 R LOW6 NI r`xI jJDR W ALL <br /> Parent material 6LflCh41L 'DRIFT" Flood plain elevation, if applicable NA ft <br /> S=Suitable for system CONVENTIONAL OUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK <br /> U=Unsuitable fors stem 14 S ❑U S ❑U 19 S ❑U S ❑U S ❑U ❑S U <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 jTw& <br /> 0 '♦ . CLASS 5 -90,10 Zj4AVEt <br /> . 2- 92 4 y �— M b M s M <br /> Ground <br /> elev. <br /> (e ft. <br /> Depth to <br /> limiting <br /> factor <br /> > 92- <br /> Remarks: <br /> Boring# <br /> Ground <br /> elev. <br /> ft. <br /> Depth to <br /> limiting <br /> factor ! it <br /> _..Ra ks. <br /> CST Name.—Please Print ll_. DOXl1✓S Phone: r�15 6 L4IS7 <br /> Address: W a5 E55-MF' <br /> Signature: Date: CST Number: <br /> ul�aad S-I3 -g5 676 <br />