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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 ti -'- <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. Parcel I.D.# <br /> C)�y- 3 kis d-10® <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)). <br /> Property Owner / Property 0. Location <br /> v r ' �7" El Govt. Lot.SFW 1/45E 1/4,S 311 T39 ,N,R/'10 E(or)v <br /> Property Owner's Mailing Address Lot# Block# Subd.Name or CSM# <br /> Po PP6'E — — <br /> City State Zip Code Phone Number <br /> Nearest Road <br /> W; <br /> ( 71,5' ) 3S EI city El Village ® wn p <br /> 115 0 J2 P <br /> New Construction Use: ❑Residential/Number of bedrooms -3 Addition to existing building <br /> ❑ Replacement ❑Public or commercial-Describe: <br /> Code derived daily flow 5-� gpd Recommended design loading rate 7 bed,gpd/ft2 • g trench,gpd/1112 <br /> Absorption area required _bed,ft2 S(c 3 trench,ft 2 Maximum design loading rate bed,gpd/ft2—,AL-trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s) 97,/ ft(as referred to site pla i benchmark) <br /> Additional designtsiita te�considerations �r— <br /> Parent material _ L2 (Q C+ I / + I I Flood plain elevation,if app icable 1% ft <br /> S = Suitable for system Conventional Mound In-Ground Pressure I AT-Grade System in Fill Holding Tank <br /> U = Unsuitable for system S ❑ U ❑ S P U S ❑ U ❑ S U ❑ S M U ❑ S � U <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 /> 7 <br /> si r5 R rs�l �— S �' CF rnv`ar 0\ S 3Y 6 7 <br /> a <br /> 3 5 Y /S Cr r* v12r- S 3 >� 7 <br /> Ground C 3-45 5 y 4 rS <br /> elev. iYl l S <br /> %,6_7ft. 5- S s s s tr gS <br /> Depth to <br /> limiting <br /> tagtor <br /> Remarks: 14a* ; Z o�\ C h aS 10 f'?o r+ <br /> Boring# <br /> �-� �, 5 Res / S C " -2r <br /> -l! 5Y 15 Cr mv<27 <br /> Its , <br /> C //-13 5 L, R V14 — S s a , I l <br /> Ground <br /> elev. <br /> Depth to <br /> limiting <br /> in. Remarks: N a r Z Y\ C ha, s o, 5 a <br /> CST Name (Please Print) Signature Telephone No. <br /> RG o y)d C. rr)o n a c, Me-- I r s 3 9 9 s 3 s s <br /> Address Date CST Number <br /> 5-3 .) 6 S , S t-;0r t l 5-J3- 9s -5 Z <br />