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Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page of <br /> Labor and Human Relations <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 81/2 x 11 inches in size. Plan must include,but <br /> not limited to vertical and horizontal reference point(BM),direction and%of slope,sc lie or PARCEL I.D.# H re <br /> dimensioned, north arrow,and location and distance to nearest road. p/bt- 33,;1 8-01/de-,L <br /> APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWSrd / DATE <br /> PROPERTY OWNER: PROPER LOCATION c Q� <br /> /� ,�o ,a .g r rn�� LOI_ S F 1/4,5a 1/4,S IV V T�7 ,N,R /� E(or)C <br /> PROPERTY NER':S MAILING ADDRESSLOT# BLOCK# SUBD.NAME OR CSM# <br /> TJ ogo G,4ke ✓i e — — <br /> CITY,STATE ZIP CODE PHONE NUMBER []CITY VILLAGE ;BFOWN NEAREST ROAD J <br /> / <br /> Sir`a� GJ� sy$ a ( )e? 9-7113° ¢ N iv it /h r�lor� - <br /> [� New Construction Use [ Residential/Number of bedrooms [ ] Addition to existing building - <br /> [ J Replacement [ ] Public or commercial describe <br /> Code derived daily flow 5Sy gpd Recommended design loading rate-bed,gpd/ft2 ,g trench,gpd/ft2 <br /> Absorption area required 611.3 bed,ft2 Yk3 trench,ft2 Maximum design Wadi g rate , 'J bed,gpd/tt2 9 trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s) It (as referred to site plan benchmark) <br /> Additional design/site considerations <br /> Parent material G/,¢c:.a / e7/r i �F` Flood plain elevation,if applicable IVA- ft <br /> S=Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSUR AT-GRADE SYSTEM IN FILL HOLDING TANK <br /> U=Unsuitable for s stem m S ❑U ®S ❑U FS ❑U ❑U EIS ❑U ❑S O U <br /> SOIL DESCRIPTION REPORT <br /> Boring # Horizon Depth Dominant Color Mottles Texture tructure Consistence rS <br /> Roots GPD/ft <br /> in. Munsell Qu.Sz.Cont.Color r. Sz. Sh. Bed Trade <br /> yy>u�iE�a�sr� ,p <br /> 0- i> rl � /S G1fr .�-co 7 .oO <br /> £t <br /> <9 ' a 7-y/ 7.5- X �4 — is <br /> /r7 S� r/�i` 3 :J r Q <br /> Ground Y/-68 7.S R � <br /> elev. <br /> ft. y 68-7� 7,S771f c aJ5 /r �� fs ,dk — <br /> Depth to <br /> limiting <br /> for,. <br /> Remarks: <br /> Boring# <br /> as <br /> 0- 6 7,s /rns` u r �5 f,C, <br /> a aH — <br /> (- Yo 7,5yR � /S ins6/C rnJtG'r s 3F-rr, <br /> 3 ya-67 7 5- if LS /..sir Jfi a{ ,s .0 <br /> Ground <br /> ely <br /> ev. 7-72 7,5-, /f �3 "d s- /t sem- <br /> Depth to <br /> limiting <br /> fac or 1 <br /> 7 <br /> Remarks: 3 S <br /> CST Name:-Please Print���� N� Phone: <br /> Address: Qp <br /> 5%11 5 ♦r r- iv c./� 5'%b'7-2 <br /> Signature: Date: CST Number: <br />