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• Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page / of .3 <br /> Labor e6nd 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 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. o 3g-7 3J q—V 900 <br /> APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWEDB„ ,� C DATE <br /> PROPERTY OWNER: PROPERTY LOCATION <br /> To PRE W 15 a, GOVT.LOT AIW 1/4.58 1/4,S 3 T N,R /1� E for W& <br /> PROPERTY OWNER'S MAILING ADDRESS LOT# I BLOCK# <br /> -1250 SIERRA CT IZO RCRES <br /> CITY,STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE ®TOWN NEAREST ROAD <br /> CH to AS E4 ►4. 5531 ( ) p <br /> X New Construction Use Residential/Number of bedrooms 3 [ ] Addition to existing building <br /> I ] Replacement [ ] Public or commercial describe <br /> Code derived daily flow $b gpd Recommended design loading rate bed,gpd/ft2 .8 trench,gpd/ft2 <br /> Absorption area required bed,ft2 S(03 trench,ft2 Maximum design loading rate •7 bed,gpd/ft2 -S trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s) q$.3 ft (as referred to site plan benchmark) <br /> Additional design/site considerations I Z•x 5q- $E0 <br /> Parent material LA GI f3L DR if cd V 3 G-G J; Flood plain elevation, if applicable NA ft <br /> S=Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL -HOLDING TANK <br /> U=Unsuitable fors stem 1&S ❑U RLS ❑U MS ❑U SIS ❑U 14S ❑U ❑S IRU <br /> SOIL DESCRIPTION REPORT <br /> Depth Dominant Color Mottles Structure GPD/ft <br /> Boring # Horizon Texture Consistence Boundary Roots <br /> ................. <br /> In. Munsell Qu.Sz.Cont.Color Gr. Sz. Sh. Bed Trench <br /> .................. <br /> ................. <br /> 1 ( 7.5 R C ZVf 7 $ <br /> 2 Z 7.5 R `f <br /> Ground <br /> elev. <br /> 100_6 ft. <br /> Depth to <br /> limiting <br /> factor <br /> � Z <br /> Remarks: <br /> Boring # <br /> 1 0-6 7.5 X 3 2- rt-- MS OMS M CS Z)f 7 8 <br /> 2»> Z ------ Ms dM5 M <br /> Ground <br /> elev. <br /> jcv�L ft. <br /> Depth to <br /> limiting <br /> 7 t r5 <br /> Remarks: , 77 C <br /> CST Name:—Please Print IC O AkS Phone: 7 <br /> Is- 966- 11IS•7 <br /> Address: i7766 <br /> W JS W,5 S-r6 <br /> Signature: Date: CST Number: <br /> -5-C- 76 0 <br />