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Wisconsin Departmentoflndustry, SOIL AND SITE EVALUATION REPORT Page of <br /> Labor and Human Relations <br /> Division of Safety 8 Buildings in accord with ILHR 83.05,Wis.Adm. Code <br /> COUNrY <br /> Attach complete site plan on paper not less than 8 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 PARC L I.D.# <br /> dimensioned, north arrow,and location and distance to nearest road. 040 - 03 -c6U <br /> APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE <br /> PROPERTYOWNER: PROPERTY LOCATION <br /> •T' p GOVT.LOT 1/4 1/4,S 6 T D ,N,R 6 E(o W <br /> PROPERTYOWNER':S AILING=ADSDRESSS� Ay, S LOT# BLOCK# SBD.N�E RCSM# <br /> ozaCITY,STATE ZIP CODE PHONEMBER ❑CITY ❑VILLAGE OWN NEAREST ROAD <br /> C E n1 . 55 23( iZi — A D D- <br /> >1 New Construction Use X Residential/Number of bedrooms 3 [ ] Acklitiontc existing building <br /> I ] Replacement [ ] Public or commercial describe <br /> Code derived daily flow i 5D gpd Recommended design loading rate .'7 bed,gpd n2__-_&_trench,gpd/ft2 <br /> Absorption area required G43 bed,ft2 5(v3 trench,ft2 Maximum design loading rate 3 bed,gpd ft2 .6 trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s) ITS-I ft (as referred to site plan benchmark) <br /> Additional design/site considerations <br /> Parent material GLAD AL- 'PRI�r Flood plain elevation,if applicable NA It <br /> IS=Suitable for SystemCO VENT NA MOUND IN-GROUND PRESSURE AT-GRADE SY TEM IN FILL HOLDING T K <br /> U=Unsuitable fors stem I Ks ❑U P1 S ❑U MS ❑U I ]K S ❑U I S ❑U ❑S U <br /> SOIL DESCRIPTION REPORT <br /> Boring# Horizon Depth Dominant Color Mottles Texture Structure Consister ce Boundary Roots GPD/ft <br /> in. Munsell Cu.Sz.Cont Color Gr. Sz. Sh. Bed jTlerich <br /> Ground <br /> elev. <br /> q�n. <br /> Depth to <br /> limiting <br /> factor <br /> Remarks: <br /> Boring# <br /> Qn�no<<b I 0-7 ?•5 � z �, 5 M I c s J v� •'T •8 <br /> � X <br /> Ground <br /> le <br /> n. <br /> Depth to <br /> limiting <br /> 7>Dt�ry <br /> Remarks: <br /> CST Name:—Please Print KI C KP otpje)wPhone: g 6 ' S <br /> Address: 277eo gw686—Mg i. 5 8 3 <br /> Signature: Date: CST Number: <br /> 3 U70 <br />