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wsconsinDepartment ofIndustry, 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 B 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 PARCEL I.D.# <br /> dimensioned, north arrow,and location and distance to nearest road. Ola• -d����C� <br /> APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE <br /> S-S Q� <br /> PROPERTY OWNER: PROPERTY LO ATION U ,� <br /> GOVT.LOT 1/4 1/4,S 3S t"Iv ,N,R 1-5 E(oro <br /> PROPERTY OWNER'S MAILING ADDRESS LOT# I BLOCK# SU D.NAME OR M#•� <br /> 2-14 3 1 Lisef 1Zfl . 0 1 <br /> CI STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE OWN NEAREST ROAD <br /> E 5TE 1 . 5 893 112) 3 • JA c oN RD- <br /> [ ] New Construction Use Residential I Number of bedrooms 2 [ ] Addition to exis ing building <br /> Replacement [ ] Public or commercial describe <br /> Code derived daily flow 300 gpd Recommended design loading rate bed,gpd$ trench,gpd/ft2 <br /> Absorption area required—17-9L-bed,ft2 437- trench,ft2 Maximum design loading rate bed,gpd/ft2 •% trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s) q b.0 n (as referred to site plan benchm k) <br /> Additional design/site considerations <br /> Parent material GL C-i 11 'DRI FT Flood plain elevation,if applicable ft <br /> S=Suitable for system CONVENTIONAL I M�gUND IN-GROUND PRESSURE AT-GRADE SY TEM IN FILL HOLDING T NK <br /> U=Unsuitable for s stem S ❑U 25LS ❑U RIS ❑U S ❑U S ❑U ❑S J291J <br /> SOIL DESCRIPTION REPORT <br /> Depth Dominant Color Mottles Texture Structure Consistence Roots GPD/ft <br /> Boring# Horizon in. Munsell Qu.Sz.Cont Color Gr. Sz. Sh. Bed jTrench <br /> r _ O r.Al CS 'Lr� $ <br /> z 6-ion1 q.S tZ Ljjq �— Ns o r•t M u I 1 8 <br /> Ground 3 b`f'90 S R ( R M 5 OMS M1 �' $ <br /> elev. <br /> Depth to <br /> limiting <br /> faf <br /> gtor <br /> Remarks: <br /> Boring# <br /> I �'s 9,5,(K 2 S OMS .$ <br /> 2 2 S 01150 <br /> Ground <br /> elev. <br /> 97_9 ft. <br /> Depth to <br /> limiting <br /> factor r� <br /> _>(pa <br /> Remarks: <br /> CST Name:—Please Print l mp O gw-s Phone: 's • _ �•� <br /> dress: 2-2760 W 35 STAR WI . �y 3 J <br /> Signature: A Date: ��umber: <br />