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Wisconsin Department of Industry, 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 /> COUNTY <br /> Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include,but 1,1e <br /> not limited to vertical and horizontal reference point(BM),direction and%of slope,scale or PARCEL I.D.If <br /> dimensioned, north arrow,and location and distance to nearest road. �a- <br /> APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWEDB f__DATE <br /> 6' <br /> PROPERTYOWNER: ,1 " � PROPERTY LOCATION <br /> 57`e0� t Rye .4/t��c�s ry GOVT.LOT,�' 1/4 1/4,Q3-T3$ ,N,R /Q E(or)0 <br /> PROPERTY OWNER':S MAILING ADDRESSp / LOT# BLOCK# SUED.NAME OR CSM# t, <br /> ,,Q300.;2 C/�vrc RoAl/ <br /> CITY,STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE OVN NEAREST ROAD <br /> 5i/ ce -,/S'7� (715) G- <br /> [ ] New Construction Use [>J. Residential/Number of bedrooms a [ ] Addition to existing building <br /> bQ Replacement [ ] Public or commercial describe <br /> Code derived daily flow-JO o gpd Recommended design loading rate - - bed,gpolft2__6 trench,gpd/ft2 <br /> Absorption area requiredya c/ bed,ft2 3 7Srench,R2 Maximum design loading rate . 7 bed,gpd/ft2 • 8 trench,gpolft2 <br /> Recommended infiltration surface elevation(s) 17717 ft (as referred to site plan benchmark) <br /> Additional design/site considerations <br /> Parent material G/AC i a r FT Flood plain elevation, if applicable /1!i¢ It <br /> 1S=Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK <br /> U=Unsuitable fors stem I ®.S ❑U 1 ISS ❑U as ❑U I EKS ❑U ®S ❑U ❑S U <br /> SOIL DESCRIPTION REPORT <br /> Depth Dominant Color Mottles Texture Structure Consistence ecurciary Roots GPD/ft <br /> Boring # Horizon in. Munsell Qu.Sz.Cont Color Gr. Sz. Sh. FBed Trends <br /> 1.5 1,en s6AC lh L,f,- [ S 3f-co <br /> `<..:U .-t s �Y/ — -• s ,,, tit m ver r9S of-co , <br /> Ground 3 dY`�,Z �/,> Ry�6 �y- S S' fS rrm3� r <br /> elev. <br /> ft. <br /> Depth to <br /> limiting <br /> factor J <br /> �• Remarks: <br /> Boring# p 3 8 <br /> S {<o <br /> & k:: <br /> .Z, � -6� 7.5 � y� f-rnS fi3� ufr ?F-cv ) f• <br /> Ground <br /> elev. <br /> Depth to <br /> limiting <br /> fa for <br /> Remarks: <br /> CST Name:-Please Print �� 3 I!�i�9.�i Phone: 7/5- Y5? »- 4K <br /> a <br /> Address: O. ✓.j L✓-7- 5V,?,?7.2 <br /> Date: <br /> Signature: CST Number: <br />