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Wisconsin Department of Industry, SOIL AND SITE EVALUATION <br /> Labor and Human Relations Page of <br /> Division of Safety and Buildings in accordance with s. ILHR 83.09,Wis. <br /> Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County <br /> include,but not limited to: vertical and horizontal reference point(BM),direction and u rN <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. parcel I.D.# <br /> o �?' a3 0 / 70v <br /> APPLICANT INFORMATION- Please print all information. Reviewed by �/✓" Date <br /> Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). l W0 <br /> Property OwnerProperty Location _ <br /> L G)1 S ye? lila Govt.Lot IL)6J 1/4 Aj0 1/4,S a T YV,N,R E(or) <br /> Property Owner's Mailing Address Lot# Block# Subd.Name or CSM# <br /> v?o 0?-;27 10o r tolu, — — <br /> City State Zip Code Phone Number Nearest Road <br /> WAucoJA L . 068 (9 5t )Sa6 X99 El city ❑' C_ ge Town S�lor'e <br /> ❑ New Construction Use: gResidential/Number of bedrooms 2 Addition to existing building <br /> (KI Replacement ❑Public or commercial-Describe: <br /> Code derived daily flow gpd Recommended design loading rate bad,gpd/ft2__j.-trench,gpd/ft2 <br /> Absorption area required ya j bed,ft2 2-�5_trench,ft Maximum design loading rate 7 bed,gpd/ft2 trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s) ���a ft(as referred to site plan benchmark) <br /> Additional design/site considerations — <br /> Parent material 5:1AC,A/ d IN/ F'f Flood plain 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 systeml KS ❑ U ®S ❑ u ,g s ❑ u Y's ❑ u Ns ❑ u ❑ s MU <br /> SOIL DESCRIPTION REPORT <br /> Boring# Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2 <br /> in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. Bed , Trench <br /> �' �3 / /ins G 5 -3FCv <br /> Ground VA, <br /> elev. <br /> Depth to <br /> limiting <br /> factor <br /> ;t2Xin. <br /> Remarks: <br /> Boring# <br /> F 7 7,4',K <br /> [3 -5-14 <br /> Ground <br /> elev. <br /> n. <br /> Depth to <br /> limiting <br /> factor <br /> min. , Remarks: <br /> CST Name (Please Print) Signature Telephone No. <br /> Address ', Date CST Number <br />