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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, but1 NIETT <br /> not limited 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. O <br /> APPLICANT INFORMATION–PLEASE PRINT ALL INFORMATION�507 3.1697 REVIE D DATE 25 . <br /> is— <br /> PROPERTY OWNER: PROPERTY LOCATION <br /> MARILYN 13POTH U N GOVT.LOT 1/4 1/4,S T 0 N,R 15 E(or W <br /> PRO ERTY OWNE ` MAILING ADDRESS LOT# BLOCK# SUED.NAME 0 CSM# <br /> ODS INI>501Z L4. 54.1 2 73 �.�. <br /> CITY,STATE ZIP CODE PHONE NUMBER ❑CITY ]VILLAGE OWN NE9 ST ROAD <br /> c tJ. Z (S0'h b v Wav <br /> K New Construction Use Residential/Number of bedrooms Z ( ] Addition to Existing building <br /> I ] Replacement [ ] Public or oommercial describe <br /> Code derived daily flow_2k0 gpd Recommended design loading rate .7 bed,gpd trench,gpd/ft2 <br /> Absorption area required q_bed,n2 375 trench,112 Maximum design loading rate gibed,gpd/ 2 •8 trench,gpd/112 <br /> Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark) <br /> Additional design/site considerations. <br /> Parent material GLAI Mp1• Flood plain elevation,if applicable n <br /> S=Suitable for systemFO_NVENTIONAL JUND IN-GROUND PRESSURE AT-GRADE TEM IN FILL HOLDING TANK <br /> U=Unsuitable for s stem S ❑U S ❑U �S ❑U •R S ❑U S ❑U ❑S )RU <br /> SOIL DESCRIPTION REPORT <br /> Depth Dominant Color Mottles Structure GPD/ft <br /> Boring Horizon Texture Consistence Boti�ay Roots <br /> in. Munsell Qu.Sz.Cont Color Gr. Sz. Sh. Bed Trench <br /> CS Z" .7 <br /> Z P bK Kir Cs Ze .-7 <br /> Ground 3 zs• s y '~' s M bK nl .-7 <br /> pLtD.e� � <br /> elev. <br /> ft. <br /> Depth to <br /> limiting <br /> factor4 <br /> Remarks: <br /> Boring# <br /> n_, c I 6 S Z S MbK M4 fr <br /> 2 z b 31 15 r fbk r Cs gm .7 $ <br /> Ground` 3!•ds ys R y N r� Ms INS M r— C_ <br /> . 7 $ <br /> elev. <br /> Depth to <br /> limiting <br /> face <br /> Remarks: ' b` <br /> ST Name:—Please Print t, Phone: <br /> RD a Al 7/37- 66- /S <br /> Address: 27760 w 3S EB WJ. .SY93 <br /> Signature: • u Date b - cis, 3C-70r: <br />