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Wisebnsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page I 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 <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. —O - 00 <br /> APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWEDB DAT <br /> PROPERTY OWNER: PROPERTY LOCATION <br /> J xy,4t -<SVU-ZER(ZEA GOVT.LOT + 1/4 1/4,S I,Z? 3q N,R 14 -M W <br /> PROPERTY OWNERSMAILING ADDRESS LOT# BLOCK# SUBD.NAME OR CSM# <br /> 3 RtE �• <br /> CITY,STATE ZIP CODE PHONE NUMBER []CITY ❑VILLAGEWN NEAREST ROAD <br /> K 4q (1A-' ) tU66- 0.477 LAISK <br /> [ ] New Construction Use-b4 Residential/Number of bedrooms 2. [ ] Addition to existing building <br /> dQ Replacement [ ] Public or commercial describe <br /> Code derived daily flow 5000 gpd Recommended design loading rate , -7 bed,gpd/ft2 . 9 trench,gpd/ft2 <br /> Absorption area required 2-9 bed,ft2 - 7s trench,ft2 Maximum design loading rate •7 bed,gpd/ft2 • 8 trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s) cita.4' " L-;4) ft (as referred to site plan benchmark) <br /> Additional design/site considerations o • To afY -D• % SA—d6 <br /> Parent material 4+ qFlood plain elevation,if applicable�. It <br /> S=Suitable for system CONVENTIONAL ,.MOUND, IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK <br /> U=Unsuitable fors stem ®S ❑U ❑S ®'U ❑S NU ❑S C U ❑S 14u ❑S 1$U <br /> I-' }) SOIL DESCRIPTION REPORT <br /> Boring# Horizon Depth Dominant Color Mottles Texture Structure Consistence Bourxiary Roots GPD/ft <br /> in. I Munsell Qu.Sz.Cont Color Gr. Sz. Sh. Bed Tmr& <br /> 1 5" t.SYR�/z• o� a IMS61< mV• Ir •-t' $ <br /> : n « • 44 M K rnJ-Ftr of 7 $ <br /> Z 5•r7 ' 7SY <br /> ' <br /> Ground. AW14 Q 1 . -7 8 <br /> elev. <br /> l.q ft. <br /> Depth to <br /> limiting <br /> factor <br /> �r <br /> LIQ` <br /> Remarks: <br /> Boring# r ar <br /> ntisbK rwi-r aoJ _1; S .b <br /> 2-.` s R '1 I ewsbK m%Xy g <br /> Z. ►s•i z• �t 14 <br /> Ground 7.SYRu+I4 Qw imk -7 i- <br /> elev. <br /> �1•�ft. <br /> Depth to - <br /> limiting <br /> factor <br /> RZ .c11, <br /> Remarks: t <br /> CST Name:—Please Print M & K Phone: <br /> Address: N6=County Lka Rd <br /> Signature: Spooner,wiDate: CST Number: <br /> (715)635-7482 /7 9 M 3(9b5 <br />