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Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page of_ <br /> Labor and Human Relations <br /> Division of.Safety 8 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 BRROCT <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. / _ 95bo <br /> APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED DATE <br /> PROPERTYOWNER: PROPERTY LOCATION <br /> E N N ETA FICE GOVT.LOT 1/4 1/4,SZ3 T 10 ,N,R S E(or W <br /> PROPERTY OWNERS MAILING ADDRESS LOT# BLOCK# SUBD.NAME OR CSM# <br /> C&VAV. 313 2. i OV6ZIAOD AVS er- <br /> CITY, T TE ZI CODE PONE NUMBER CITY , VILLAGE KOWN NEAREST ROAD <br /> 5f L ( IZ) S3 - 039 rJ VEeuq nln CI P' . <br /> K New Construction Use pQ Residential/Number of bedrooms ] ] Addition to existing building <br /> I I Replacement [ ] Public or commercial describe <br /> Code derived daily flow 2 gpd Recommended design loadin rate •1 bed,gpd/ft .$ trench,gpolft2 <br /> Absorption area required 2 bed,ft2 IS% trench,ft2 Maximum design loading rate .? bed,gpd/ft2 . $ trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s) 113.1 ft (aslreferred to site plan benchmark) <br /> Additional design/site considerations <br /> Parent material GLAOAI DRIP=C Flood pain elevation, if applicable NA ft <br /> S=Suitable for system CCcVEMIONAL MOUND IN-GROUND PRESSUR AT-GRADE SYSTEM IN FILL HOLDING TANK <br /> U=Unsuitable for s stem F9 S ❑U S ❑U S ❑U 5aS ❑U IK S ❑U ❑S sw I <br /> SOIL DESCRIPTION REPORT <br /> Boring # Horizon Depth Dominant Color Mottles Texture tructure Consistence Boundary Roots GPD/ft <br /> in. Munsell Qu.Sz.Cont Color Cr. Sz. Sh. Bed Therch <br /> 7- 7-5a Ms s M I cs t 8 <br /> Ground 3 -6`1 7•S R 4 '{ ��J ►� MS Nt 8 <br /> elev. <br /> 9(Q.S ft. <br /> Depth to <br /> limiting <br /> factor •. <br /> 7 foo <br /> Remarks: �' G9 1 / 7 Q 44- /5 BA,-)bS <br /> Boring # <br /> 0 7 -7 Q 3 z r—� Ms its #A Cs 7- <br /> N. •? 5 <br /> Ri <br /> 7- (o?- 7.S g q 4 r-- Ms w n,s ra l cs .? 8 <br /> 3 62-47 IS,41Z 4 4A f NfLs ms 014s ,KI .$ <br /> Ground <br /> elev. <br /> ft. <br /> Depth to <br /> limiting <br /> to for ., <br /> Z <br /> Remarks: S 3. <br /> CST Name:—Please Print Phone: <br /> If-AA120 OOKff/ 7/S - $(b • 15 <br /> ddress: Z-17(x0 w 35" 1��8STEx 1nll- .��8 3 <br /> Signature: Date: CST Number: <br /> -IML 6 <br />