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WiisconsinDepartment ofIndus", SOIL AND SITE EVALUATION REPORT Page_of_ <br /> Labor and Human Relations <br /> Division of Safety&Buildings in accord with ILHR 83.05,Wis.Adm. Code <br /> COU07 <br /> Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include,but &tXfjM <br /> not limited to vertical and horizontal reference point(BM),direction and%of slope,scale or PARC L I.D.#�•'') <br /> dimensioned, north arrow, and location and distance to nearest road. <br /> APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIE ED BY DATE <br /> PROPERTY OWN,f R: PROPERTY LOCATION <br /> E GOVT.LOT 1/4 1/Itoxisting <br /> T 0 ,N,R 16 E(or W <br /> PROPERTY OWNEH':S MAILING ADD LOT# BLOCK# SUBD.NAMSM# <br /> Z D. O <br /> CITY,STATE ZIP CODE PHONE NUMBER []CITY ❑VILLAGE OWNNEAREST ROAD <br /> S'r6 1• .54893 ( ) 0 <br /> [ ] New Construction Use( Residential!Number of bedrooms 2 ( ] Additiobuilding <br /> DQ Replacement [ ] Public or commercial describe <br /> Code derived daily flow 300 gpd Recommended design loading rate .7 bed,gpd/ 2 • $ trench,gpd/ft2 <br /> Absorption area required qA bed,ft2 315 trench,1112 Maximum design loading rate bed,gpd/ 2 trench,gpd1ft2 <br /> Recommended infiltration surface elevation(s) 95.1 ft (as referred to site plan benct mark) <br /> Additional design/site considerations <br /> Parent material DRIFT" Flood plain elevation, if applicable N14 ft <br /> S=Suitable for system ONVENTIONAL I MOUNDIN-GROUND PRESSURE AT-GRADE TEM IN FILL HOLDIN T K <br /> U=Unsuitable fors stem S ❑U S ❑U 2YTEM <br /> ❑U $(S ❑U S ❑U ❑S U <br /> SOIL DESCRIPTION REPORT <br /> Depth Dominant Color Mottles Texture Structure ConsistenceRoots GPD/ft <br /> Boring# Horizon in. Munsell Qu.Sz.Cont Color Gr. Sz. Sh. Boundary Bed ITw& <br /> $ <br /> 7.S n 2 7�--- is nufr cs r .7 <br /> `�1 2 6- 1 7.S R �{ �`J /s �•F /� J'F cs Zn . � ,$ <br /> Ground 3 19-91 7.5 R 6 " '' 51 2 M CW •'� <br /> Depth to <br /> limiting <br /> factgr-- <br /> Remarks: <br /> Boring # <br /> ID-6, 7. R 3 Z 15 kik Mvf CS ZM 7 •$ <br /> W. <br /> is 1 6 MJ Cs 7-M 7 <br /> -38 7-51k 4h, ^' 51 2 rm Mv- 0.5 M - 3 <br /> Ground <br /> 9 sft y 3a 78 R Is Ifbk MVA 1 B <br /> Depth to <br /> limiting <br /> factor� <br /> Remarks: <br /> CST Name:—Please Print fe_NglZD Phone: 115- ,366- <br /> Address: <br /> S- 66-ddress: 21760 W _15- <br /> SSignSignature: <br /> ature: Date: CST Number: <br /> Ka4a 367o <br />