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WiisconsinDepartment ofIndustry, 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,butBLIRAIETr <br /> not limited to vertical and horizontal reference point(BM),direction and%of slope,scale or PARDE I.D.# <br /> dimensioned, north arrow,and location and distance to nearest road. _; y 1U_ Oy-460 <br /> APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIE ED DA``TE <br /> 1'1,1� <br /> PROPERTY OWNER: PROPERTY LOCATION u <br /> /< GOVT.LOT / 1/4 1/4,S T q0 ,N,R 14 E(o<W) <br /> PROPERTY OWNERS MAILING ADDRESS LOT# BLOCK# SUBD.NAME 0 <br /> Z E ZIP D. (_\g F. I <br /> CITY,S ATE CODE PHONE NUMBER ❑CITY ❑VILLAGE 2ZOWN NEAREST ROAD <br /> P \41 . St4SOI (115)63S - Z V. <br /> [ ] New Construction Use [)(] Residential/Number of bedrooms 3 [ ] Addition to zisfing building <br /> Iq Replacement [ ] Public or commercial describe <br /> Code derived daily flow gpd Recommended design loading rate 1 bed,gpdM2 $ trench,gpd/ft2 <br /> Absorption area required bed,t12 5403 trench,ft2 Maximum design loading rate .'7 bed,gpd 2 ,$ trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s) 100.9 ft (as referred to site plan bench ark) <br /> Additional design/site considerations <br /> Parent material 4LAG4FlL PR r j:T Flood plain elevation, if applicable NA ft <br /> S=Suitable for System CONVENTIONAL MOUND N-GROUND PRESSURE AT-GRADE YSTEM IN FILL HOLDING T NK <br /> U=Unsuitable for s stem IpQ S ❑U 54 S ❑U &S ❑U (g S ❑U W S ❑U ❑S WU <br /> SOIL DESCRIPTION REPORT <br /> Boring # Horizon Depth Dominant Color Mottles Texture Structure consistenca Baxx4ly Roots GPD/ft <br /> in. Munsell Qu.Sz.Cont Color Gr. Sz. Sh. Bed Trend <br /> 2M .7 .8 <br /> -5 7.5 R 3/Z ��-- MS OMs d I CS <br /> z <br /> 5-70 7-S a H 4 — Ms Mz dl f 7 8 <br /> Ground <br /> elev. <br /> longi a. <br /> Depth to <br /> limiting <br /> factor <br /> Remarks: <br /> Boring # <br /> I 0-6 7•S R 3 .7 .$ <br /> 7- 6.70 7.syq qlq �— Ms DMS cll1 •7 •8 <br /> Ground <br /> elev. <br /> 1= 1 ft <br /> Depth to <br /> limiting <br /> factor <br /> 70„ <br /> 7 <br /> Remarks: <br /> CST Name:—Please Print 90 APkJA15 <br /> Phone: S_ 66- <br /> Address: 2� 6o w WF�sr ¢ 3 <br /> Signature: Date: CST Number: <br />