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Labor and Human <br /> Rel tof ions Industry, SOIL AND SITE EVALUATION REPORT Pae I of <br /> Labor and Human Relations g <br /> Division of safety a Buildings in accord with ILHR 83.05,Wis.Adm. Code <br /> COU Y Q <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 # <br /> dimensioned, north arrow, and location and distance to nearest road. Q C�d''30p <br /> APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIE ED BY DATE <br /> PROPERTY OWNER:_ PROPERTY LOCATION <br /> C 4'1>4 /0/t.l 7'07AL=Xs GOVT.LOT14,5vJ1/4.Su1 1/4,S f T qO ,N,R /7 E(oeW <br /> PROPERTY OWNER':S MAILING ADDRESS LOT# BLOCK# SUBD.NAME RCSM# <br /> 3/ G�EiV c 1'/�. 5&/ TE 335 <br /> CITY,STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE NFOWN NEAREST ROAD <br /> MAIL, ✓• 5 ((,/2) 8Nc/-34- lUt AJ ery Ali) F <br /> [ ] New Construction Use Residential/Number of bedrooms 4 Addition to existing building <br /> Replacement [ ] Public or commercial describe <br /> Code derived daily Bow 6CIC gpd n Recommended design loading rate _bed,gpd! 2 X trench,gpd/ft2 <br /> Absorption area required�bed,ft2 ?5,D trench,ft2 Maximum design loading rate _bed,gpd 2 it trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s) %7 � it ft (as referred to site plan benchmark) <br /> Additional design/site considerations <br /> Parent material SAN of Tr C 59A-1) Flood plain elevation, if applicable A.P- -- ft <br /> S=Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT GRADE SYSTEM IN FILL HOLDING TANK <br /> U=Unsuitable for s stem IRS ❑U 'WS ❑U QS ❑U WC ❑U EIS N U ❑S Z�U <br /> SOIL DESCRIPTION REPORT <br /> Boring# Horizon Depth Dominant Color Mottles Texture Structure Consistence Bounday Roots GPD/ft <br /> in. Munsell Qu.Sz.Cont.Color Gr. Sz. Sh. Bed Trend <br /> ?© 7., '' r-- tis e S <br /> / i' 72 F <br /> >.._.. _0 7.5 !2 )fig 7 , d <br /> Ground 'a!^'>!i 7. <br /> elev. <br /> Depth to <br /> limiting <br /> factor <br /> 2 u <br /> Remarks: BfelcC- MOE- lDir <br /> Boring # <br /> 7" 7.7 2LL <br /> Ground` 3 D � 7.S `/ A'ota ns <br /> /oC-o ft. <br /> 71 <br /> Depth to <br /> limiting <br /> factor <br /> 7 ,1,r <br /> �� Remarks: <br /> CST Name:—Please Print �C Phone: 3 1� <br /> 7/— z yv Sz <br /> Address: & 3-- vb30 <br /> Signature: Date: CST Number: <br /> en 2 _ /�- <br /> ('.VW <br />