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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 ��� <br /> not limited to vertical and horizontal reference point(BM),direction and%of slope,scale or PARCE I.D.# 1 <br /> dimensioned, north arrow,and location and distance to nearest road. y� c <br /> - ! 1--?60 <br /> APPLICANT INFORMATION—PLEASE PRINT ALL INFORMATION REVIEA ED BY �AA7E'q�S, <br /> PROPERTYOWNER: PROPERTY LOCATION <br /> O/ll GOVT.LOT J01064 N f.L)1/4,S p T Y ,N,R /y E(orx@ <br /> PROPERTY OW R':S MAILING ADDRESS LOT# I BLOCK# SUBD.NAME OR CSM# <br /> CITY,STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILVl,aGE ®TOWN NEAREST ROAq e n� <br /> Q/o mNL, a/a 17v8)Sa9-`/6/a Scc7* .¢c1 us 11 <br /> [�-(New Construction Use �q Residential/Number of bedrooms oZ [ ] Addition to Existing building — <br /> [ I Replacement [ ] Public or commercial describe — <br /> Code derived daily flow��' gpd Recommended design loading rate bed,gpd trench,gpd/tt2 <br /> Absorption area required bed,ft2 .,3 7.5—trench,ft2 Maximum design loading rate 7 bed,gpd 2 • F trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s) _ft (as referred to site plan benchmark) <br /> Additional design/site considerations M e;j'T , S C /a we 1's <br /> Parent material G 14 c / Fl- d r/4t Flood plain elevation,if applicable It <br /> S=Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE I AT-GRADE SYSTEM IN FILL HOLDING TANK <br /> U=Unsuitable &S ❑U RS ❑U S ❑U ILS ❑U ❑S ZU <br /> SOIL DESCRIPTION REPORT <br /> Boring# Horizon Depth Dominant Color Mottles Texture Structure ConsistencD Boundary Roots GPD/ft <br /> in. Munsell Qu.Sz.Cont.Color Gr. Sz. Sh. Bed Trend& <br /> /S /(vtt4 e) r C S 131-<c, "7 1 9 <br /> Ground -$o p — A)s o 5 _C4 M — F <br /> elev. <br /> ft. <br /> Depth to <br /> limiting <br /> factor <br /> Remarks: 4 b- nJc/us 0lt/5 <br /> Boring# <br /> 0_6 7 S YA 3 /S s k /M✓f r c S 3f<n <br /> ,aap <br /> ...h -39 /o M y/ - /S >nrsd rnuf S 3f-� <br /> Po /0'Zf 11/6 — s os ,,,! — 3f i, 8 <br /> Ground <br /> elev. <br /> ft. <br /> Depth to <br /> limiting <br /> factor <br /> >So <br /> Remarks: /i4 mit G/us;o.vS ]� `1a3 <br /> CST Name:—PleasePrint.._,,�'/.— Phone: .) � y�—���� <br /> Address: 16G .QaX .S/y S/i/tC� <br /> Signature: B Date: CST Number: <br />