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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 /+/U"e_ <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. Parcel I.D.# <br /> © /Q 4 <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 /> / w Govt.Lot �� 1/4A /„ 1/4,S 1 T 3 8 ,N,R <br /> Property Owner's Mailing Address,!� Lot# Block# Subd.Name or CSM# <br /> q Cv, q <br /> City State zip cocTe Phone Number <br /> ❑ City El Village Town Nearest Road <br /> New Construction Use: (Residential/Number of bedrooms Addition to existing building <br /> ❑ Replacement ❑Public or commercial-Describe: j <br /> Code derived daily flow d t1 gPd Recommended design loading rate ,7bed,gpd/ft2�trench,gpd/f12 <br /> Absorption area required bed,ft2 3 <br /> c�y� trench,ft2 Maximum design loading rate bed,gpd/fh D trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s) ft(as referred to site plan benchmark) <br /> Additional design/site considerations <br /> Parent material Flood plain elevation,if applicable /1-)AL� ft <br /> S = Suitable for system Conventional �M7lound In-Ground Pressure AT-Grade System in Fill Holding Tank <br /> U = Unsuitable for system S U µu S ❑ U FZ S ❑ U 10S ❑ U I 9S ❑ U ❑ S ® U <br /> SOIL DESCRIPTION REPORT <br /> Boring # Horizon Depth Dominant Color Mottles Structure GPD/ft2 <br /> in. Munsell Qu.Sz.Cont.Color FTexture Gr.Sz.Sh. Consistence Boundary Roots <br /> Bed Trench <br /> -7Bed <br /> 6� cs ��a ,7 .9 <br /> Ground . S <br /> elev. ' <br /> 9�ft. <br /> Depth to <br /> limiting <br /> factor <br /> Vin. <br /> Remarks: <br /> Boring # 0 -23 <br /> 7s ,�% <br /> Ground <br /> elev. <br /> Wit. <br /> Depth to <br /> limiting <br /> factor <br /> fin. Remarks: <br /> CST Name (Please Print) Signature Telephone No. <br /> Address Date CST Number <br /> /.�© syr --.2_57- 9,2' <br />