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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. Adm. Code <br /> Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must Co my <br /> include,but not limited to: vertical and horizontal reference point(BM),direction and <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. parcel I.D.# <br /> no 02S 01 q00 <br /> APPLICANT INFORMATION- Please print all information. Reviewed by Date l <br /> Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). <br /> Property Owner ' Property Location <br /> 649 Govt.Lot 1/4 1/4,S T40 N,R b E(or <br /> Property Owner's Mailing Address Lot# Block# I Subd.Name or CSM# <br /> J 39 q MACIZ a i1.j 2 CONNOri - AD <br /> City State Zip Code Phone Number Nearest Road <br /> ' PAUL <br /> IMO. ��1 (��' ) El ❑ Village _W( Town <br /> ❑ New Construction Use: Residential/Number of bedrooms Addition to existing building <br /> JfSt�T Replacement ❑Public or commercial-Describe: <br /> Code derived daily flow 0�00 gpd Recommended design loading rate—W—bed,gpd/ft2 trench,gpd/ft2 <br /> Absorption area required bed,ft2 trench,ft Maximum design loading rate bed,gpd/fl2 trench,gpd/t2 <br /> Recommended infiltration surface elevation(s) ft(as referred to site plan benchmark) <br /> Additional design/site considerations <br /> Parent material CRt Flood plain elevation,if applicable Ni1g ft <br /> S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank <br /> U = Unsuitable for system ❑S U ❑S U ❑ S li4 U ❑ S ® U ❑S O u XS ❑ u <br /> SOIL DESCRIPTION REPORT <br /> Boring# Horizon Depth Dominant Color Mottles Structure GPD/ft2 <br /> dary Roots <br /> in. Munsell Qu.Sz.Cont.Color Texture Gr.Sz.Sh. Consistence Boun <br /> Bed , Trench <br /> I J0-7 I cs 8 <br /> v <br /> 1-l0 7.5vyx4 s s C/ 4Pfy <br /> ,Z' .3 <br /> Ground ? 0_ 51,61 lrt ;hve P1r 7G6 Z • 3 <br /> elp.v. <br /> " s /Z czarAIRI6Gs 2M Np Me <br /> Depth to, �' d x S 8 M r . 4 . <br /> limiting <br /> factor <br /> —T—in. <br /> Remarks: <br /> Boring # <br /> J O6 32 <br /> 2 2 6 JZ s)C, .2- A <br /> 3 1'1.2 COW( .r S C NP <br /> Ground .4 .S <br /> -P�ft <br /> Depth to <br /> limiting <br /> Yor <br /> in. Remarks: lt! <br /> CST Name (Please Print) gnature Telephone No. <br /> Is S <br /> Address Date CST Num er <br /> �L 01 <br />