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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 )gAh5r'' <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. 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 /> O _ 14EEWI�j4ep, Govt.Lot57 1/4 1/4,S T 0 ,N,R G E(or <br /> Property Owner's Mailing Address Lot# Block# Subd.Name or CSM# <br /> ;-7437- ?5`I_`-% ST. E. 4 <br /> City }J13-State Zip Code Phone Number ❑ City ❑ Village Town Nearest Road <br /> x %jF,gqKovc MtJ 550"16 <br /> ❑ New Construction Use: 5dResidential/Number of bedrooms Addition to existing building <br /> hpril Replacement ❑Public or commercial-Describe: <br /> Code derived daily flow 300 gpd Recommended design loading rate .7 bed,gpd/ft2 . g trench,gpd/ft2 <br /> Absorption area required 429 bed,ft2 375' trench,ft2 Maximum design loading rate •Z bed,gpd/ft2 • $ trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s) (y• Q ft(as referred to site plan benchmark) <br /> Additional design/site considerations <br /> Parent material G txl�la� Dgi.Pr Flood plain elevation,if applicable NkIr 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 EK S ❑ U X S ❑ U EK S ❑ U S ❑ U ❑ S � U <br /> SOIL DESCRIPTION REPORT <br /> Bolin # Horizon Depth Dominant Color Mottles Structure GPD/ft2 <br /> 9 Texture Consistence Boundary Roots <br /> in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. Bed , Trench <br /> ,.,1. •5 .S n s 2 �- Ms .7 . $ <br /> 2 2 MS 8 <br /> Ground <br /> lev. <br /> ft. <br /> Depth to <br /> limiting <br /> factor <br /> Remarks: H14Pfp Ak4a� l2fyjf <br /> Boring # <br /> -5 -3/2- <br /> 72 S <br /> Ground <br /> elev <br /> g6.�ft. <br /> Depth to 77 <br /> limiting r�3 <br /> factor <br /> 7�in. Remarks: iYan/b A909 800C)h ; <br /> CST Name (Please Print) Signature Telephone No. <br /> re-i4n 1,•1 lS 464' LIIS7 <br /> Address Date CST Number <br /> 1:7,760 <br /> s lr1�Bs W1• �1$ 3 $- q- 3470 <br />