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Wis <br /> Labor and Department Rel tiolndustry, SOIL AND SITE EVALUATION REPORT Pae _ <br /> Labor and Human Relations g _Of <br /> Division of Safety a Buildings in accord with ILHR 83.05,Wis.Adm. Code <br /> COON <br /> Attach complete site plan on paper not less than 8 1/2 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. <br /> APPLICANT INFORMATION—PLEASE PRINT ALL INFORMATION REVIE NED BY DATE <br /> PROPERTYOWNER: PROPERTY LOCATION <br /> GOVT.LOT 1/4 1/4,S T ,N,R E(or)W <br /> PROPERTY OWNERS MAILING ADDRESS LOT* BLOCK# SUBD.NAME RCSM# <br /> CITY,STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE ❑TOWN NEAREST ROAD <br /> [ ] New Construction Use [ ] Residential/Number of bedrooms [ ] Addition to existing building <br /> ( ] Replacement [ ] Public or commercial describe <br /> Code derived daily flow gpd Recommended design loading rate bed,gpd/ 2 trench,gpd/ft2 <br /> Absorption area required bed,ft2 trench,ft2 Maximum design loading rate bed,gpd/t2__trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s) ft (as referred to site plan ben&mark) <br /> Additional design/site considerations <br /> Parent material Flood plan elevation,if applicable ft <br /> S=Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK <br /> U=Unsuitable for s stem ❑S ❑U ❑S ❑U ❑S ❑U E]S ❑U ❑S ❑U ❑S ❑U <br /> SOIL DESCRIPTION REPORT <br /> Boring # Horizon Depth Dominant Color IMottles Text re Structure Consisten Roots GPD/ft <br /> in. Munsell Qu.Sz.Cont Color Gr. 5Z.Ah. Bed Trerd <br /> &COP <br /> Ground JQ , <br /> elev. <br /> ft. S <br /> Depth to <br /> limiting <br /> factor <br /> Remarks: <br /> Boring # <br /> -m <br /> Ground <br /> elev. <br /> ft. <br /> Depth to <br /> limiting <br /> factor <br /> Remarks: <br /> CST Name:—Please Print Phone: <br /> Address: Zo <br /> Signature: Date: CST Number: <br />