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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 4 L4 r ti e- / I <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. parcel I.D.# <br /> a.s3s © 3 <br /> APPLICANT INFORMATION- Please print all information. Reviewed by Date p <br /> Personal infonnafion you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). � lO--A(l-/ <br /> Property Owner. Property Location C' <br /> 2 C Ct Govt.Lot S C-- 1/4,$ L 1/4,S S T ,N,R E(or) <br /> Property O er's Mailing Address Lot# IBlock# Subd.Name or CSM# <br /> G - — — <br /> city Stafe Zip Code Phone Number <br /> '�e� !`! �� 15292 71 ) -S' a [:1 city El EF,60 /\ LNearest// dGcJooJ/ LK <br /> New Construction Use: gResidential/Number of bedrooms Addition to existing building <br /> Replacement ❑Public or commercial-Describe: <br /> Code derived daily flow QQ gpd Recommended design loading rate - �r bed,gpd/ft2 6 trench,gpd/ft2 <br /> Absorption area required��bed,ft2 05'0 trench,ft2 Maximum design loading rate bed,gpd/f12 0'-� trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s)_ ft/(as referred to site plan benchmark) <br /> Additional design/site considerations -74 <br /> Parent material 6 /J�C";'. / d'^I !Ff Flood plain elevation,if applicable <br /> S = Suitable for system I <br /> Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank <br /> U = Unsuitable for system I ❑ S P.U ❑S U ❑S KU I ❑ S ® U ❑ S O-U 59-S ❑ U <br /> SOIL DESCRIPTION REPORT <br /> Boring # Horizon Depth Dominant Color Mottles Structure GPD/ft2 <br /> Texture Consistence Boundary Roots <br /> N in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. Bed Trench <br /> darD 7,cS�,f/�C <br /> Ground 3 d�D �� '/A 3�y C :,-?cJ3 <br /> elev. <br /> Depth to <br /> limiting <br /> factor <br /> Lin. <br /> Remarks: <br /> Boring# <br /> .�.�51k _ �3 <br /> Ground <br /> elev. <br /> T7dft. <br /> Depth to <br /> limiting <br /> factor <br /> j Lin. Remarks: <br /> CST Name (Plea?e Print) Signature / Telephone No. <br /> Address Date CST Number , <br /> 1-3 <br /> ,2-7-74a 9/ <br />