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Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page of <br /> Labor and Human Relations <br /> Division of Safety a Buildings in accord with ILHR 83.05,Wis.Adm. Code <br /> COU <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,scale or PARCEL I.D.# <br /> dimensioned, north arrow, and location and distance to nearest road. O) 'S3a.S=O 3')W <br /> APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIE ED � Cr_DATE <br /> PROPERTYOWNER: PROPERTY LOCATION <br /> �/n (,,Je_6 e-,-" GOVT.LOTI•i�E1/4 .5W 1/4,S S'f Jq ,N,R / E(or'C <br /> PROPERTY OWNER':S MAILING ADDRESS LOT# BLOCK# SUB .NAMED CSM <br /> CITY,STATE ZIP CODE PHONE NUMBER []CITY [-]VILLAGEMOWN NEAREST ROAD <br /> G✓o � ir1, - - - VI-J 23 -G7,11 c n, o n/ �e K. or <br /> [ New Construction Use D4 Residential/Number of bedrooms ( ] Addition to existing building <br /> [ ] Replacement [ ] Public or commercial describe — <br /> Code derived daily flow gpd Recommended design loading rate • "7 bed,gpd/ trench,gpd/ft2 <br /> Absorption area required y.S bed,ft2 3 7�'trench,ft2 Maximum design loading rate_Lbed,gpd/ 2 P trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s) 9.5. 45� ft (as referred to site plan bench ark) <br /> Additional design/site considerations /' efv/e— 6t� A <br /> A) - es J/�s <br /> Parent material G/,¢c i;/ cy'^ Flood plain SavaIon,if applicable eV 4- ft <br /> S=Suitable for systemCLONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK <br /> U=Unsuitable fors stem S ❑U ;.S Z U ®S ❑U I ❑S U ❑S U ❑S �U <br /> SOIL DESCRIPTION REPORT <br /> Boring # Horizon Depth Dominant Color Mottles Texture Structure Consisten Boundary Roots GPD/ft <br /> in. Munsell Qu.Sz.Cont Color Gr. Sz. Sh. Bed Tw& <br /> �I <br /> �j �t'r .S .3f-co <br /> Ground -3 3-ay I a.n54K s f . 3 Y <br /> elev. <br /> Depth to <br /> limiting <br /> factor <br /> 7 Sa <br /> Remarks: <br /> Boring # B 3 <br /> /0,Y/1 1.2 so <br /> Fn2 s a S-/o 7S � % _ �5 ms6 u-Fr• S .3f<o , 7 .P <br /> lD-,2/ 7574 ��a S'J <br /> Ground <br /> elft // /-767,3 �s/� /`7S <br /> Depth to <br /> limiting <br /> factor <br /> > 76 <br /> Remarks: $3 <br /> CST Name:—Please Print }� �AyFS�aY� Phone: <br /> Address: <br /> Signature: Date:. CST Number: <br />