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Wisconsin Department of Industry, 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 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. 016-33;_I -0-3 <br /> ` <br /> APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED DATE <br /> PROPERTY OWNER: PROPERTY LOCATION -7c-/ <br /> C 4 i^in ,L�� GOVT.LOT _14:,1/4 S C 1/4,Spg'T g N,R JG E(or)0 <br /> PROPET OWNER':S MAILING ADDRESS LOT# I BLOCK# SUBD.NAME OR CSM# <br /> y. /3 — — <br /> CITY,STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE [3TOWN NEAREST/ROAD / <br /> /nJ bsll>♦ �N. j S-7g';0 (S07)YS 0e / C E/Jd/�.� /YJ tel/ d[..i/L' d <br /> [ New Construction Use Residential/Number of bedrooms o2 [ ] Addition to existing building <br /> [ ] Replacement [ ] Public or commercial describe — <br /> Code derived daily flow _ n c.; gpd Recommended design loading rate ; bed,gpd/ft2 trench,gpd/ft2 <br /> Absorption area required r_'bed, ft2 .�7 75- trench,ft2 Maximum design loading rate bed,gpd/ft2 } trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark) <br /> Additional design/site considerations - <br /> Parent material C'f w c '-'4 / Flood plain elevation,if applicable /UfJ- ft <br /> S=Suitable for system CONVENTIONAL MOUND N-GROUND PRESSURE AT-GRADESYSTEM IN FILL HOLDING TANK <br /> U=Unsuitable fors stem Jos ❑U as El KS [IU (9 S ❑U 9 ❑U ❑S ®U <br /> SOIL DESCRIPTION REPORT <br /> Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft <br /> in. Munsell Qu.Sz.Cont.Color Gr. Sz. Sh. Bed (Trench <br /> Lja- 7.s i %� — /S /ten s 6K rn rFr C S-7.� 7'>' ✓�� `- �.5 liy, -�" ✓ �' _ jF-tom � , � <br /> Ground <br /> elev. <br /> j ft. <br /> Depth to <br /> limiting <br /> 'fac7�,� <br /> Remarks: <br /> Boring# <br /> 7-S 1f — -5 3r-co 7X. .� <br /> 7, 511") <br /> Ground <br /> elev. i <br /> ft. <br /> Depth to <br /> limiting <br /> factor , <br /> 77..7 <br /> Remarks: <br /> CST Name-.-Please Print `� /� Phone: <br /> Address: .Qo lisC`� tet' J �, nJ Lam✓f �7 <br /> Signature: i )� Date:�- y� CST Number <br />