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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 t! ^N <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. Parcel I.D.# <br /> .2- - <br /> APPLICANT INFORMATION- Please print all information. Revidwea by Date /1f� <br /> Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). <br /> Pro arty Owner <br /> Property Location G <br /> it/cf S o Govt.Lot �f`1/4s 1/4,S,5--T�r N,R/e E(oteW <br /> Property Owne Mailing Add ss Lot If Block# Subd.Name or CSM# <br /> 6 6� <br /> City State Zip Code Phone Number ❑ City ❑ Villa e Ne g 1A Town est Road <br /> 8-New Construction Use: (Residential/Number of bedrooms Addition to existing building r, <br /> ❑ Replacement ❑Public or commercial-Describe: �— <br /> Code derived daily flow-700 gpd Recommended design loading rateJ bed,gpd/fiz._trench,gpd/ft2 <br /> Absorption area required Z O D bed,ft2 -d0 trench,ft2 Maximum design loading rate ed,gpd/i2 <br /> _trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s) 5? 57-1 19 <br /> ft(as referred to site plan benchmark) <br /> Additional design/site considerations ' <br /> Parent material (S�f� i,4 / C/ r t Flood plain elevation,if applicable ��i�- ft <br /> S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank <br /> U = Unsuitable for system 5aS ❑ U 5;IS ❑ U ❑ U )KS ❑ U I (KS ❑ U I ❑ S <br /> SOIL DESCRIPTION REPORT <br /> Boris # Horizon Depth Dominant Color Mottles Structure GPD/ft2 <br /> 9 Texture Consistence Boundary Roots <br /> in. Munse/ll� Qu.Sz.Cont.Color Gr.Sz.Sh. Bed , Trench <br /> F S <L <br /> Depth to <br /> limiting <br /> for <br /> fa4 in. <br /> Remarks: <br /> Boring# <br /> 5 -� T I .. <br /> dk 6 <br /> Ground <br /> elev. <br /> n' <br /> Depth to <br /> limiting <br /> factor <br /> 4_in. Remarks: <br /> CST Name (Please Print) Signature Telephone No. <br /> ddress Date CST Number <br />