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Wisconsin Department ofIndustry, SOIL AND SITE EVALUATION REPORT Page_of <br /> Labor arld Human Relations <br /> Division of Safety a Buildings in accord with ILHR 83.05,Wis.Adm. Code <br /> COUNTY <br /> Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include,but u gm <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. 0`�-0 — 3 CIW <br /> APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIE B TF <br /> PROPERTY OWNER: PROPERTY LOCATION <br /> MARK LACEK GOVT.LOT3 114. 1/4,SZ,3 T-. [O ,N,R 16 E(or@W <br /> PROPERTY OWNER':S MAILING ADDRESS LOT# BLOCK# SUBD.NAME OR CSM# <br /> 1 o RD• Z OL. to F. <br /> CITY,S ATEIP CODE PHONE NUMBER ❑CITY [-]VILLAGECI OWN NEAREST ROAD <br /> 85T52 Wt. A 3 ( I Ott D $A 1L5 N Rn- <br /> D(] New Construction Use Residential/Number of bedrooms [ ] Addition to existing building T <br /> [ ] Replacement [ ] Public or commercial describe <br /> Code derived daily flow 600 gpd Recommended design loading rate ? bed,gpd/ft2 .:8 trench,gpd/ft2 <br /> Absorption area required SSS bed,ft2 trenc ,ft2 Maximum design loading rate 7 bed,gpd/ft2 •$ trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s) �, ACr It (as referred to site plan benchmark) <br /> Additional design/site considerations <br /> Parent material 6LACl,9L DRIFf Flood plain elevation,if applicable NA ft <br /> S=Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK <br /> U=Unsuit ips ❑U I P S ❑U MS ❑LI I KIS ❑U MS ❑U ❑S )RU <br /> SOIL DESCRIPTION REPORT <br /> Depth Dominant Color Mottles Structure GPD/ft <br /> Boring# Horizon Texture Consistence BoLlrxiaty Roots <br /> In. Munsell Qu.Sz.Cont Color Gr. Sz. Sh. Bed Trmnch <br /> MI <br /> ...... ..„..: 2 Z�I <br /> Ground 3 2q-bo 7.5 R 4 A OM55 M1 <br /> elev. <br /> q bo-7q <br /> -7.S�K Lflq !`' MS QMS MI "I r •� .� <br /> Depth to <br /> limiting <br /> factor�•, <br /> Remarks: <br /> Boring # PP <br /> 0- 4 7.5 K 3 2 � ' /5 OmS M t CS 2.v <br /> 2 ' z. 4- 2,77 7.5 a 4 �l r---- IS oMs l cs r .S <br /> Ground h5 <br /> elev. 66-75 7-S JK 4/%j DM 1 <br /> �loi-1 ft. <br /> Depth to <br /> limiting <br /> factor <br /> > 75 <br /> Remarks: 6 <br /> CST Name:Please Print ici4n pP 'tts Phone: /5 O'er _ /.s <br /> Address: 2.-7760 14yVY 3S W6esrioz W/ 893 <br /> Signature: •/ , Date: CST Number: <br /> 6l.InawA 5-7 ' 6 .3670 <br />