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Wisconsin Department of Industry, SOIL AND SITE EVALUATION <br /> Labor and Hu=n 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 andffe'e /U e,4 <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. Parcel I.D.# <br /> APPLICANT INFORMATION- Please print all information. t l�/S22 viey( by ' Date <br /> Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). /� I r/ <br /> Property Owner Property Location P i 6 <br /> �j 5+ E�'-J Govt.Lot N L:�— 1/4 mlC1/4,S,7 7 T G ,N,R f E(or)W <br /> Property Owner's Mailing Address L�)t# Block# d.Plameor CSM# <br /> ,6 -16 /v,4/ 40e.Y `� 02 P 7 <br /> City State Zip Code Phone Number Nearest Road <br /> 1014,411- ❑ city ❑ Village Eig. Town L 4e a 6 <br /> New Construction Use: residential/Number of bedrooms QZ Addition to existing building <br /> Replacement Public or commercial-Describe: <br /> Code derived daily flow el-5-0 gpd Recommended design loading rate bed,gpd/f?--,L trench,gpd/ft2 <br /> Absorption area required 693 bed,n2 J5X3 trench,n 2 Maximum design loading rate bed,gpd/fl? 18 trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s) /�.7 11�� c. 9�3 It(as referred to site plan benchmark) <br /> Additional design/site considerations <br /> Parent material Glia C iaj Flood plain elevation,if applicable ti A n <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 f?�S ❑ U S U As ❑ u ❑ S � u <br /> SOIL DESCRIPTION REPORT <br /> Boring# Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2 <br /> MZ „ in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. Bed Trench <br /> / 1 —S 7.5 YR 3/2 ---------- is lmsbk mvfr cs 3f—co .7 .8 <br /> 2 S--J9 7.5 YR 4/6 --------- is lmsbk mvfr Re 3f—co .7 .8 <br /> Ground <br /> elev. 3 IY-2fiq 7.5 YR 5/6 ----------- s 08R ml -- 3f—co .7 <br /> Depth to <br /> limiting <br /> factor <br /> ZZin. <br /> Remarks: <br /> Boring # -- <br /> '. ' 7 ------------- <br /> 2 -a7.5 YR 416 gs 3f—ca <br /> 3 /` — <br /> Ground <br /> elev. <br /> Ott. 3 <br /> Depth to / <br /> limiting <br /> factor <br /> , in. Remarks: <br /> CST Name (Please Print) Signature Telephone No. <br /> Address leDate CST Number <br /> ,Bo X -5-- 7— <br />