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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 County <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. pa I I.D.# <br /> (ft 43ff6 O 00 <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 <br /> Property Owner Property Location / <br /> MIKE ?rA66K Govt.Lot — 404—E 1/4,S3rp T40 ,N,R 1(, E(o W <br /> Property Owner's Mailing Address Lot# Block# Subd.Name or CSM# <br /> MR, J J`-- S <br /> City State Zip Code P one Number ❑ CiVillage �+ Town Nearest Road <br /> city ❑ <br /> I -S�I021 ( Its 2- 42 Kc Ccs- RD 7 <br /> New Construction Use: Residential/Number of bedrooms Z- Addition to existing building <br /> Replacement ❑Public or commercial-Describe: <br /> Code derived daily flow 300 gpdRecommended design loading rate bed,gpd/ft2 • 5 trench,gpd/112 <br /> Absorption area required bed,ft2 (/o0 trench,n2 Maximum design loading rate bed,gpd/fl2 • '7 trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s) �4-C) It(as referred to site plan benchmark) <br /> Additional design/siteeconsiderations <br /> Parent material GLAclut- nI wr Flood plain elevation,if applicable Nfa ft <br /> S = Suitable for system I rConventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank <br /> U = Unsuitable for system Xv S ❑ U I)a S ❑ U IRS ❑ U 9 S ❑ U Sas ❑ U ❑ S [�O U <br /> SOIL DESCRIPTION REPORT <br /> Boris # Horizon Depth Dominant Color Mottles Structure GPD/ft2 <br /> Boring in. Munsell Qu.Sz.Cont.Color Texture Gr.Sz.Sh. Consistence Boundary Roots Bed .Trench <br /> v-s 7,K_ �h / 5 ass sy l G5 trf r 7 <br /> C-33 7,Sy� <br /> Ground3 3_�/ 7137 M /$ 059 yr I '95 <br /> eley. <br /> 7 <br /> Depth to <br /> limiting <br /> fact r <br /> �� in. <br /> Remarks: <br /> Boring # <br /> 0--10 7.SyA 31 /S 05g Yv, I C S <br /> ZL 10-4.3 Zs-Y4 V/ — /S 7 0S5 <br /> H3-6 118i1b /3 C ofm146/L rnvt/r C.5 rd- <br /> Ground 5`y /o YR s/3 I�/�SYR�B' C n, <br /> ele�v„ , <br /> Depth to <br /> limiting <br /> factor <br /> 4'9 in. Remarks: <br /> CST Name (Please Print) Signature Telephone No. <br /> 1(44 A/ - 41-57 - <br /> Addrest Date CST Number <br /> ZZ 8v <br />