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Wisconsin Department of Industry, SOIL AND SITE EVALUATIONnN (� ' 1 <br /> v <br /> Labor and Human Relations V ' Page of <br /> Div°sion of Safety and Buildings in accordance with s. ILHR 83.09, Wis. Ad <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 UfZ <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. Revieweed 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 /> GHF,5f: RO Govt.Lot 1/4 1/4,S 2p T j ,N,R lei. E(or OW <br /> Property OwndVs Mailing Address Lot# Block# Subd.Name or CSM# <br /> OAK <br /> I Vi kiA VOL, - 1.3 P. 28 AOOIt1 P 1JD. I <br /> City State Zip Code Phone Number ❑ City ❑ Villap,9 Town Nearest Road <br /> ,� <br /> HOLME4 iW1 S4(o3Vo ( (00&5n-44 CO- P-0- A <br /> ❑ New Construction Use: Residential/Number of bedrooms 4 Addition to existing building <br /> Replacement ❑Public or commercial-Describe: <br /> Code derived daily flow �00 gpd Recommended design loading rate • 7 bed,gpd/fl2 g trench,gpolft2 <br /> Absorption area required bed,ft2sb0 trench,ft2 Maximum design loading rate 17 bed,gpd/fl2 .$ trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s) ft(as referred to site plan benchmark) <br /> Additional design/site considerations te <br /> Parent material GLACIAL DRIgr Flood plain elevation,if applicable fVA it <br /> S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank <br /> U = Unsuitable for system ❑ S XU S ❑ U ❑ S IOU ❑ S ® U ❑ S IRU ❑ S MU <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 <br /> Bed Trench <br /> Ground 2 �— �S DS J6)- Gt S 2.M S 6 <br /> Iv <br /> ft. I•I`lE4 4 CIL S s a dh M S <br /> Depth to <br /> limiting <br /> factor <br /> lin. <br /> Remarks: <br /> Boring # <br /> Is 635 KI 5 to 7 8 <br /> - �} �— Mf 2 uo 1 $ <br /> ¢ C2A flR P <br /> Ground <br /> (Blleev.. <br /> Depth to <br /> limiting <br /> f�actt <br /> !—�in. Remarks: <br /> CST Name (Please Print) Signature Telephone No, <br /> c fw S <br /> Adbress Date CST Number <br /> 7-1-760 1- <br />