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Wisconsin Department of Industry, 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 /> COUNTY <br /> ,Attach complete site plan on paper not less than 8 1/2 x 11 inches in size.Plan must include,but °�� e ! r <br /> not limited to vertical and horizontal reference point(BM),direction and%of slope,scale or PARCEL I.D.#(� p <br /> dimensioned,north arrow,and location and distance to nearest road. <br /> APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BYW�-D T E <br /> PROPERTY OWNER: PROPERTY LOCATION c-/ iN <br /> G,4 / E/}S/ GOVT.LOT _S 6r 1/4s E 1/4,S Re T 3 7 N,R ,/ E(ot[W:) <br /> PROPERTY OWNER':S MAILING ADDRESS LOT# BLOCK# SUBD.NAME OR CSM# <br /> A aX 8 <br /> CITY,STATE ZIP CODE PHONE NUMBER [-]CITY ❑VILLAGE ®TOWN NEAREST ROAD <br /> [A New Construction Use[3S] Residential/Number of bedrooms [ ] Addition to existing building <br /> [ ] Replacement [ j Public or commercial describe <br /> Code derived daily Flow 3CO gpd Recommended design loading rate , 7 bed,gpd/0 ,8 trench,gpd/ft2 <br /> Absorption area required'�2 bed,ft2 37-5� trench,it? Maximum design loading rate 7 bed,gpd/ft2 s trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s) q3_, 7 It (as referred to site plan benchmark) <br /> Additional design/site considerations <br /> Parent material r- / cz'r.t t Flood plain elevation,if applicable ft <br /> S=Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK <br /> U=Unsuitable fors stem ®S ❑U �xs ❑U j&S ❑U RS ❑U KS ❑U je S ❑U <br /> SOIL DESCRIPTION REPORT <br /> Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft <br /> Boring# Horizon in. Munsell Qu.Sz.Cont Color Gr. Sz. Sh. Bed jTlerch <br /> .7 .8 <br /> 7.5 YR 3/2 ----------- is lmsbk mvfr cs 3f-c4 <br /> > 2 S S3 7.5 YR 5/6 ---------- is lmsbk mvfr gs 3f-c .7 .8 <br /> Ground 35"3-/,°! 7.5 YR 5/6 ----------- fs lmsbk mvfr gs 3f-cc .5 .6 <br /> elev. <br /> Alft. 4 ��-7 7.5 YR 5/8 c2d 5 YR 5/8 f lmsbk mfr — -- NA INA <br /> Depth to <br /> limiting <br /> factor <br /> IV <br /> Remarks: <br /> Boring# <br /> 1 _� 7.5 YR 3/2 --------- is lmsbk mvfr cs 3f-c .7 .8 <br /> 2 5 7.5 YR 5/6 is lmsbk Mi <br /> 3f-r- <br /> 0 <br /> }bt.. <br /> 3 �l��oZ 7.5 YR 5/6 ---------- fs lmsbk <br /> Ground <br /> elev. 4 7a-7� 7.5 YR 5/8 c2d 5 YR 5/8 fs lmsbk <br /> 7, ft. <br /> Depth to <br /> limiting <br /> factor <br /> Remarks: , <br /> CST Name:—Please Print � Phone: <br /> Address: Q / S / -r` G✓ ^ '�/97.E <br /> Signature: / Date: CST Number: <br />