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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. <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 /,N <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. parcel I.D.# <br /> 7'1- <br /> 0 a0 yaps 0 a yod <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)). �i / /7/r✓ <br /> Property Owner Property Location L J <br /> A/.e— A, Govt.Lot 1/4 1/4,SJ.2 T 5,e6 ,N,R /t/ E(or)e/ <br /> Property Owner's Mailing Address Lot# Block# Subd.Name or CSM# <br /> 4/0�� 7' w ^ 1 <br /> City State Zip Code Phone Number Nearest Road <br /> oc'.ti !` w" S YPG ( )$L6—Y,;47 E3 city o El Village rows y,N c <br /> 9 New Construction Use: 8 Residential/Number of bedrooms Addition to existing building <br /> ❑ Replacement ❑Public or commercial-Describe: <br /> Code derived daily flow d gpd Recommended design loading rate—,t-2—bed,gpd/ft2 e 8 trench,gpd/ft2 <br /> Absorption area required lq/a 9f bed,ftZ trench,ft2 Maximum design loading rate j2 bed,gpd/flz 9 trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s) /Pep/c'9 S. I tt(as referred to site plan benchmark) <br /> Additional design/site considerations _ <br /> Parent material G.OtAc_r al d r.' C.4 Flood plain elevation,if applicable <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 ❑ S ❑ U ❑ S ❑ U ❑S ❑ U ❑ S ❑ U <br /> SOIL DESCRIPTION REPORT <br /> Boring# Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2 <br /> in. Munsell Ou.Sz.Cont.Color Gr.Sz.Sh. Bed Trench <br /> 1 0-6 7.5 YR 3/2 ----------- is lmsbk mvfr cs 3f-co .7 .8 <br /> C3 2 -3/ 7.5 YR 4/6 ------------- is lmsbk mvfr gs 3f-co .7 .8 <br /> Ground 3 -76 7.5 YR 5/6 ------------- s os ml 3f-co .7 .8 <br /> elev. -- <br /> Depth to <br /> limiting <br /> factor <br /> >74in. <br /> Remarks: <br /> Boring# <br /> -5 ----------- <br /> Da2l2 5'--a <br /> 3 2 9- — <br /> Ground <br /> elev. <br /> Depth to <br /> limiting `lam <br /> factor <br /> ?�in. Remarks: <br /> CST Name (Please Print) Signature Telephone No. <br /> Address Date CST Number <br />