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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 <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. , parcel I.D.# <br /> /2 223 Soo <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 /> CLIFF SC11906_VEK Govt.Lot 1/4 1/4,S;?5 T 1 ,N,R �5" E(oq <br /> Property Owner's Mailing Address Lot# Block# Subd.Name or CSM# <br /> SO7`I' GA19F`TO AJ A✓. 5 . 2 VOL. I P 1.51 <br /> City State Zip Code Phone Number ❑ City ❑ Village Town Nearest Road <br /> LOMV94960VEI M4 ssoi(� (G t Z )y5939g5 :Y 501'j i Co_ <br /> ❑ New Construction Use: X Residential/Number of bedrooms Addition to existing building <br /> Replacement ❑Public or commercial-Describe: <br /> Code derived daily flow �0 gpd Recommended design loading rate 10; bed,gpd/ft2 _trench,gpd/ft2 <br /> Absorption area required _bed,ft2 trench, <br /> trench,ft2 Maximum design loading rate—" bed,bed,gpd/ft2 trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s) NA ft(as referred to site plan benchmark) <br /> Additional design/site considerations <br /> Parent material G/AGIAL 'nRIRT' Flood plain elevation,if applicable 1(13 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 ❑ S U ❑S '0 U ❑S IZ U ❑ S Ru WS ❑ u <br /> SOIL DESCRIPTION REPORT <br /> Boling # Horizon Depth Dominant Color Mottles Structure GPD/ft2 <br /> in. Munsell Qu.Sz.Cont.Color Texture Gr.Sz.Sh. Consistence Boundary Roots <br /> Bed , Trench <br /> 1 I 3 cs -I a <br /> 2 3 I 7.5 4/116 MS om <br /> Ground 3 12 10l•S R -6 2 Sq A CA MS I OMS M cb .— •`1 ,$ <br /> e`1 . <br /> ft 7.S R 9 �5 MS OMS MI js r .7 S <br /> Depth to 5 7•S R o '�' S OMS M( s.— 1 •$ <br /> limiting <br /> factor ' <br /> r in. <br /> Remarks: rJ -R 1 <br /> Boring# <br /> Ground <br /> elev. <br /> n. <br /> Depth to <br /> limiting <br /> factor <br /> in. Remarks: <br /> CST Name (Please Print) Signature Telephone No. <br /> tctpwo 415-7 P <br /> Address Date CST Number <br /> 27760 -t 35 EBS1�R 11Jt. 5{893 - 11 • 36*7o <br />