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Wisconsin Department of Industry, SOIL AND SITE EVALUATION Page / of <br /> Labor and Human Relations <br /> oiv�ft,Y Safety and Buildings in accordance with s. ILHR 83.09,Wis. t1 <br /> Attach complete sits plan on paper not less than 81/2 x 11 inches in size. Plan must <br /> Cou <br /> Include,but not limited to: vertical and horizontal reference point(BM),direction and u RNE <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. Parc I.D.# <br /> APPLICANT INFORMATION- Please print all information. Reviewed Date <br /> Personal Information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). <br /> Properly Owner Property Location <br /> D L GovL Lot3 1/4 1/4,S /3 T3 9 ,N,R /� �$(or)W <br /> properly Owner's Mailing of# Block# Subd.Name or CSM# <br /> EL <br /> rsy 7 �7S r <br /> City State Zip Code Phone Number ,.,,/ Nearest Road <br /> ❑ City ❑ villag L7 Town oc k A <br /> co C"i f SrOI <br /> -1t 7, 5'oa <br /> ( New Construction Use: M%eesidential/Number of bedroo Addition to existing building <br /> ❑ Replacement ❑Public or commercial-Describ <br /> Code derived deity f1ow&dY9a6M(gpd V 4 v Recommended design loading rate_, 7 bed,gpolfF . Y' trench,gpolttz <br /> Absorption area required y bad,ft21/ trench,ft2 Maximum design loading rate_.j..Lbed,gpd/ft2 y trench,gpd/ft2 <br /> Recommended infiltration surface eievation(s) 9y / ft(as referred to site plan benchmark) <br /> Additional design/site considerations <br /> Parent material r/LAC z1L. Lw;''-r Flood plain elevation,if applicable Ar ft <br /> S Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank <br /> U = Unsuitable for system 0 ❑ U �S ❑ u E s El U Lrts- � u ❑ s CST �s 23-T <br /> SOIL DESCRIPTION REPORT <br /> Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2 <br /> in. Munsell Ou.Sz.Cont Colo Gr.Sz.Sh. Bed , Trench <br /> 13 ;L S. <br /> -3;L <br /> Ground 7 - �' - s o — 7 <br /> elev. <br /> /s uft. <br /> Depth to <br /> limiting <br /> factor <br /> ZZ.I;n. <br /> Remarks: <br /> Boring# i _ c s / 7 ; 8 <br /> l 7 , P <br /> 7 8 <br /> Ground <br /> elev. <br /> Depth to <br /> enrfting <br /> factor <br /> 7 al�sin. Remarks: <br /> CST Nemo (Please Print) Si natu Teleptlone No. <br /> CE -L SG�e%gNE 12 7 S-- s-32 v <br /> Address <br /> Date CST Number <br /> 7.3/G Z 0,YZXTAk .PD YELL LARe 0 87/ If-A5.- <br />