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Wisconsin Department of Industry, SOIL AND SITE EVALUATION Page of <br /> Labor and Human Relations <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 and13"R4gir <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. Parcel I.D.# <br /> M =9 0 <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 Location _ , <br /> DAAAV u Govt.Lot l 1/4 1/4,S I Tia ,N,R E(or(9 <br /> Property Ownerls Mailing Address Lot# Block# Subd.Name or CSM# <br /> city State Zip Code Phone Number A O Nearest Road <br /> (�. 55gg7 c 12155 - 3Z El city ❑ Village W Town Mowir n) <br /> New Construction Use: Residential/Number of bedrooms Addition to existing building <br /> Replacement Public or commercial-Describe: <br /> Code derived daily flow 30D gpd Recommended design loading rate .7 bed,gpd/ft2trench,gpd/ft2 <br /> Absorption area required!I7-9 bed,ft2 . �trranc h <br /> 2. p Maximum design loading rate •7 bed,gpd/ft2trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s) Q�. f NU 7�. 1 ft(as referred to site plan benchmark) <br /> Additional design/site considerations <br /> Parent material &XI AL OR Ier Flood plain elevation,if applicable NA ft <br /> S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank <br /> U Unsuitable for systemi RS ❑ u KS ❑ U 9s ❑ u iZI s ❑ u 4 s ❑ u ❑ s Au <br /> SOIL DESCRIPTION REPORT <br /> Boring # Horizon Depth Dominant Color Mottles Texture Structure Cdnsistence Boundary Roots GPD/ft2 <br /> in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. Bed Trench <br /> -5 7-51rltz 14S 4k -1 -S <br /> 13 7- S.(PI .SIlk 4 "- 14S oms Im .7 .$ <br /> Ground (01-481 l.S R 4 cl kif S19- 519 tts I timsex M I I Its <br /> qey <br /> ft. o _ ^ 1Jf N1' <br /> Depth to <br /> limiting M f ctf ctor <br /> in. <br /> Remarks: <br /> Boring# <br /> I .S4 R 31Z r� s 7 '.•9 <br /> 2 Z R V Ms .7 8 <br /> 3 1,54,41q Af g tsa Ms .7 ' .a <br /> pGround <br /> ft. <br /> Depth to 2 <br /> limitingfpLogir ,` V �y <br /> in. Remarks: <br /> CST Name (Please Print) Signature Telephone No. <br /> /S- S46 - ` YS77 <br /> Address Date CST Number <br /> 2,7740 w 35 UaMM 111. 5 893 LLS - 77 34,70 <br />