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Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page ot_ <br /> Labor and Human Relations <br /> Division of Safety&Buildings in accord with ILHR 83.05,Wis. Adm. Code <br /> COU <br /> Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include,but <br /> nottrmited to vertical and horizontal reference point(BM),direction and%of slope,scale or PARCE I.D.# <br /> dimensioned, north arrow,and location and distance to nearest road. &100 <br /> APPLICANT INFORMATION–PLEASE PRINT ALL INFORMATION REVIE DBY DATE <br /> �o_ _�,-- <br /> PROPERTY OWNER: PROPERTY LOCATION / <br /> Ou R <br /> KES ER r b <br /> GOVT.LOT 1/4 1/4,S T d ,N,R b E(o W <br /> PROPERTYOWNER)SIo DDDRE S L7–OT BLOCK# S B�I.NAMEO CSM '( <br /> CITY,STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE KOWN N AREST ROAD <br /> flRROn1 1 . 8 2 ( 1 KL%9W O <br /> [�New Construction Use➢Q Residential/Number of bedrooms 2- [ ] Addition to existing building <br /> [ ] Replacement [ ] Public or commercial describe <br /> Code derived daily flow-300 gpd Recommended design loading rate bed,gpd/ 2 trench,gpd/ft2 <br /> Absorption area required ZQ bed,tt2 trench.R2 Maximum design loading rate bed,gpd/1t2 trench,gpd/ft2 <br /> Recommended infiltration surface eleft (as referred to site plan benchmark) <br /> Additional design/site considerations <br /> Parent material (4LACIAL. '(7iZtFT Flood plain elevation,if applicable MA ft <br /> S=Suitable for system CONVENTIONAL I MOUNDIN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK <br /> U=Unsuitable fors stem 'KS ElU '®S ❑U us ❑U S ❑U ®S [] <br /> S ❑U ❑S JKLI <br /> SOIL DESCRIPTION REPORT <br /> Boring# Horizon Depth Dominant Color Mottles Texture Structure ConsistenceBoundary Roots GPD/ft <br /> n. Munsell Qu.Sz.Cont.Color Gr. Sz. Sh. Bed jTrench <br /> .? S <br /> 6. D S K �- I5 QM S M ] ZM • ? S <br /> Ground <br /> elev. <br /> %.0 ft. <br /> Depth to <br /> limiting <br /> factor ^v <br /> Remarks: <br /> Boring# <br /> 97" 1 B <br /> 'L Z 0 7.S R `1 �_— �S QMJ M C S 7 8 <br /> Ground <br /> ev <br /> ft. <br /> Depth to <br /> limiting <br /> factoru <br /> �1 Remarks: <br /> T Name:—Please Print f Li4RO Phone: <br /> Address: Z?1 0 #Wq 36 W1, 3 <br /> Signature: Date: CST Number: <br /> • z . r c <br />