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Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page I of3 <br /> Labor and Human Relafions <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 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 PARCEL I.D.O <br /> dimensioned, north arrow,and location and distance to nearest road. ..yslL)-dL]' o� <br /> APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEV EDBY DATE <br /> +11- <br /> PROPERTY OWNER: PROPERTY LOCATION <br /> t GOVT.LOT 1/4 _ 1/4,S T o ,N,R E(orS <br /> PROPERTY OWNERS MAILING ADDRESS LOT# BLOCK# SUBD.NAMEO CSMIf <br /> 5 6 / S <br /> C TATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE NgFeWN NEAREST ROAD 6 ! <br /> N c <br /> [krNew Construction Use [„} Residential/Number of bedrooms [ ] Addition to existing building A14 <br /> [ ] Replacement [ ] Public or commercial describe <br /> Cade derived daily flow�5n gpd Recommended design loading rate bed,gpd/ 2 trench,gpolft2 <br /> Absorption area required .:)15 bed,f12 1 B trench,9 Maximum design loading rate__r7 bed,gpd/l trench,gpolft2 <br /> Recommended infiltration surface elevation(s) X7 ft (as referred to site plan benchmark) <br /> Additional design/site considerations - (a <br /> Parent material j> Ac.a Flood plain elevation,if applicable �4a ft <br /> $=Suitable to System CONVEMIONAMOUND INBOUND PRESSURE AT-GRADE SYSTEM IN JLL H❑OLS NC�/�IK <br /> U=Unsuitable for s stem S Elul ❑S [�1 QSI 5 ❑U ❑S � ❑S jn RA <br /> 11 <br /> SOIL DESCRIPTION REPORT <br /> Depth Dominant Color Mottles Texture Structure Consisten Bouldaly Roots GPD/ft <br /> Boring # Horizon in. Munsell Qu.Sz.Cont Color Gr. Sz. Sh/.� Bedr Trertdt <br /> «;,@_`i�a`r<a SIL �l ✓F <� 2 -..'9 . J .b <br /> Ground N� No1Vr_ 111' JS _ — <br /> eleN. <br /> V-I�ft. <br /> Depth to <br /> limiting <br /> factor <br /> Remarks: <br /> Boring# <br /> / 0— 31 / ,c jI yn5�✓� Y11�� S 5cc) 5 <br /> t;1 r0owcE, a7 <br /> m n <br /> Ground <br /> elev. <br /> Depth to <br /> limiting <br /> __d v <br /> Remarks: <br /> T Name:—Please Print AR& Phone: / 6 —7/4 <br /> Address: ` e L?.nt E ks, 5 <br /> Date: T Number: <br /> Signature: <br />