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Wis:onsinDepartmentofIndus", SOIL AND SITE EVALUATION REPORT PageLof�_ <br /> labor and Human Relations <br /> ;Division or 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 PARCEL I.D.# <br /> not limited to vertical and horizontal reference point(BM),direction and%of slope,scale or <br /> dimensioned, north arrow,and location and distance to nearest road. <br /> APPLICANT.INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE <br /> PROPERTY OWNER: PROPERTY LOCATION <br /> L 3LD§ 0 GOVT.LOT &p 1/4 114,s7 T q6 ,N,R E(o W <br /> PROPE 0 NER':S MAILING ADDRESS LOT# BLOCK# SUBD.NAME OR CSM# <br /> CITY,STATE$sI ZIP ODE O PHONE NUMBER ❑CITY ❑VILLAGE OWN NEAREST ROAD <br /> 71A BuR Wl . Sg83v ( f51259 - 3cilio KujogxE RD - <br /> New Construction Use[ ] Residential/Number of bedrooms [ ] Addition to existing building <br /> j ] Replacement 'b4_ Public or commercial descritte 0 $Ep�coM "[Q W N Ito M E <br /> Code derived daily flow I SOO gpd Recommended design loading rate _bed,gpd/ft2 •$ trench,gpd/ft2 <br /> Absorption area required, 2-14 3 bed,9 ($75 trench,fl? Maximum design loading rate bed,gpd/ft2 -$ trench,gpd/ft2 <br /> Recommended infiltration surface elevations) SSA Rt_T $7.3 ft (as referred to site plan benchmark) <br /> Additional design/site considerations <br /> Flood plain elevation,if applicable ISA ft <br /> Parent material 4 LA C f aL 'DRIFT <br /> S=Suitable for system C NVENTIONAL MOUND N- ROUND PRESSURE AT-GRADE SY TEM IN FILL HOLDING T NK <br /> U=Unsuitable fors stem i9S ❑U V S ❑U �S ❑U S ❑U S ❑U ❑S U <br /> SOIL DESCRIPTION REPORT <br /> Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft <br /> Boring# Horizon in. Munsell Qu.Sz.Cont.Color Gr. Sz. Sh. Bed Tltjrtdt <br /> Z' . <br /> C5 20-( -Z ;.8 <br /> Z -75 MS OKS01 µl 1 g <br /> Ground <br /> ft <br /> Depth to <br /> limiting <br /> factor <br /> Remarks: <br /> Boring# H1 CS Z4 -I <br /> I 0-S 7.S K 513:— <br /> ru <br /> Z S-?D ?:S K '�'' Ks M _ 5 ,-7 <br /> Ground <br /> elev. <br /> Depth to <br /> limiting <br /> factor el <br /> �Q <br /> Remarks: <br /> T Name:—Please Print .&IWO Phone: _ pi_i _ 's <br /> (Ion <br /> Add <br /> rem 2.7760 lqkju3S WEBSfL bJl• .$ySg3 <br /> Signature• - _. Date: Number: <br /> 4- 2s - 3-5- <br /> ,� <br />