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sc Department of Industry, SOIL AND SITE EVALUATION <br /> x+t and Human Relations Page--L of <br /> ,vision.of Safety and Buildings in accordance with s. ILHR 83.09, Wis. <br /> Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must County <br /> include,but not limited to: vertical and horizontal reference point IBM),direction and <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. Parcel I.D.# <br /> 3 y- /5/.? 0 3SCC� <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)). �0 <br /> Property Owner �- Property Location <br /> 0�1 <br /> A. fr �Q —1 O n S�orte, Govt.Lot P V+- 11+,S- T 3 7 ,N,R / 'fir)W <br /> Property Owner's Mailing Address Lot# Block# I Subd.Name or CSM# <br /> yB'/5 14LAt I — C-SM i1W 7 <br /> City State Zip Code Phone Number N arest Road <br /> /,J -fie Mfr nt , SS//0 ( ) El city ❑ Village o Loa-Al-'s L4 ¢- <br /> E6 Kew Construction Use: E91re-sidential/Number of bedrooms 3 Addition to existing building <br /> ❑ Replacement ❑Public or commercial-Describe: <br /> Code derived daily flow q50 gpd Recommended design loading rate 0.7 bed,gpd/ft2 OL trench,gpd/ft2 <br /> Absorption area required�N3 _bed,ft2 563 trench,ft2 Maximum design loading rate-CL-7-bed,gpd/ft2 `Y trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s) 9S/S ft(as referred to site plan benchmark) <br /> Additional design/site considerations rina�/�r>e6I '& bF rcdi cej do tura nEA,n rt►aL�C CdV�a yZ4�d�Sbibw�iir� (P����3• <br /> Parent material g�QC'��cLC dcc Wa.S C Flood plain elevation,if applicable nA n <br /> S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank <br /> U = Unsuitable for system I 0'S" El D'S El `�, ❑ U �❑ U ❑� ❑ U ❑ S <br /> SOIL DESCRIPTION REPORT <br /> Boring# Horizon Depth I Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2 <br /> in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. Bed Trench <br /> CS 3C4m 0.7 'o.f <br /> C2 -X io YR'/W /ion . /,S I rrf she d Q 3&,VL o• '.0•P <br /> Ground 3 5 0 ( Q L, BEd I d• �.� <br /> elev. <br /> 9 .90ft. r. s vi�,k I Cts F' 0. 7 'O•P <br /> Depth to <br /> n� s Qs FIAI - - Q. OJ <br /> limiting <br /> factor <br /> in. <br /> Remarks: <br /> Boring# / 0- /O V02 /?orle /5 i K. env CS 340.7 OX <br /> 07 r. /S rrr 56K MVA- C'5 3,< /g 0.7,3, 0$ <br /> 3 x. 15 0s 4 ; 5 0.7 a.8 <br /> Ground 35�69 S h ovy S <br /> elev. ll�te �. S Ply nA ( — D. 7 ,0,9 <br /> 9ft. S �y� o <br /> 0.7 '04T <br /> Depth to <br /> limiting . <br /> factor <br /> > C&L..Remarks:--Y e5 ,m E v5 51154r2 C 6&e-s <br /> CST Name (Please Print) _ Signatur Telephone No. <br /> ami �---�TY/i�ln'� Cars aye-3a�/ <br /> Address Date CST Number <br /> 34vo �ta.�so>7 �' DSccoCa W4 S�/0� Q97 C5rM # Cb? <br />