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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 UQ� � <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. parcel LD.# <br /> 14 2=& 03 406 <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 /> Govt.Lot 13 114 1/4,S (p T %,N,R IS E(orQW <br /> Property Owner's Mailing ddress- Lot# I Block# Subd.Name or CSM# <br /> City State I Zip Code Phone Number <br /> ❑ City El Village ® Town Nearest Road <br /> $t IMICAAuLF I M[4 . 55 '1 t Glz)890 311qI L.4 rou,64M i W o <br /> ❑ New Construction Use: SIResidential/Number of bedrooms 2 Addition to existing building <br /> 9 Replacement ❑Public or commercial-Describe: <br /> Code derived daily flow —Soo gpd Recommended design loading rate bed,gpd/ft2__!�k trench,gpd/ft2 <br /> Absorption area required 600 bed,ft2trench,ft2 Maximum design loading rate .S bed,gpd/ff2 .G trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s) 96.1 ft(as referred to site plan benchmark) <br /> Additional design/site considerations <br /> Parent material GLpdJAL DR 14g{' Flood plain elevation,if applicable PA ft <br /> S = Suitable for system I Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank <br /> U = Unsuitable for system I MS ❑ U KS ❑ U X S ❑ U 1 ® S ❑ U RZS ❑ U ❑ S 19 U <br /> SOIL DESCRIPTION REPORT <br /> Boring# Horizon Depth Dominant Color Mottles Structure GPD/ft2 <br /> Texture Consistence Boundary Roots <br /> m. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. Bed , Trench <br /> Ground <br /> I v. <br /> Qn. 4 z ,&414 <br /> Depth to <br /> limiting <br /> factor <br /> >7;Piin. <br /> Remarks: Ah =10.4. <br /> Boring If r� <br /> Ground <br /> elev. <br /> .o <br /> fl <br /> Depth to <br /> limiting <br /> factor <br /> ;�Mn. Remarks: <br /> CST Name (Please Print) Signature Telephone No. <br /> Fleollp-0 F-14" 4X7 <br /> Address Date CST Number <br /> �11&D 1,/' Wl, Son12- 14-4R ZzS�S <br />