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:onsin'Department of Industry, SOIL AND SITE EVALUATION REPORT Page_Lof� <br /> odr and Human Relations <br /> vision of Safety&Buildings in accord with ILHR 83.05,Wis.Adm. Code <br /> COU <br /> Attach complete site plan on paper not less than 8 112 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.# _ _ <br /> dimensioned, north arrow,and location and distance to nearest road. � —CS"7 5' –CM <br /> APPLICANT INFORMATION–PLEASE PRINT ALL INFORMATION REVIEWED DAJE <br /> PROPE OWNER: _ PROPERTY LOCATION <br /> TO 1 S (-Jk Viz_ GOVT.LOT 1/4 1/4,S T q6 ,N,R I E(d&W <br /> PROPERTY OWNER':S MAILING ADDRESS L BLOCK* I SUED.NAME OR CSM# <br /> � ! G SrriJ 772 lGGtJ �lfJG Svn/ <br /> CITY STATE "'CODEPHONE MBER ❑CI []VILLAGE OWN NEAREST ROAD <br /> v 6j/ 4,� vye 1�6 - <br /> [ ] New Construction Use Residential!Number of bedrooms IV, r] Addition to Existing building <br /> Replacement J J Public or commercial describe <br /> Code derived daily flow .300 gpd Recommended design loading rate -7 gpd/ i� trench,gpd/ft2 <br /> Absorption area required�bed,ft2 375&ch,ft2 Maximum design loading rate bed,gpd! trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s) !�22� n K ft (as referred to site plan bench ark) <br /> Additional design/site considerations Z5 DrC' GS /), r Qo x7-) <br /> Parent material T Z( Flood plain elevation,if applicable It <br /> S=Suitable for system C NVENTIONAL MO ND 1 - OUND PRESSURE AT- DE SYSTEM INFILL HOLDING K <br /> LI=Unsuitable for s stem S ❑U ❑U ❑U ❑U ❑S ❑S U <br /> SOIL DESCRIPTION REPORT <br /> Boring# Horizon Depth Dominant Color Mottles Texture Structure Consisteno, Boundary Roots GPD/ft <br /> in. Munsell Qu.Sz.Cont.Color Gr. Sz. Sh. Bed Ttendl <br /> � <br /> < G z 7 <br /> et 1Z" �,� fz y �S ✓1153 n� <br /> Ground �' <br /> e/lev.4 <br /> �j i ft. <br /> Depth to <br /> limiting <br /> factor ,v <br /> Remarks: <br /> Boring# u N <br /> 5 45 f5- <br /> Z 2 -!G" 7,CvL �rL t7 <br /> a., <br /> 71j_!J12 AV 1475 61:2; <br /> Ground <br /> elei. ,r <br /> �ft. <br /> Depth to <br /> limiting <br /> factor <br /> Remarks: '�— <br /> CST Name:—Please Print Phone: lf_ <br /> Address: 10713 �ti3v/.f / -;8 e0 <br /> Signature: Date: ` CST Number: <br /> '04465- <br /> A? <br />