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Wisconsin Departmert of Industry, SOIL AND SITE EVALUATION <br /> Labor and Fg ran Relations Page of <br /> pig of gay and 13ui dmF in accordance with s. ILHR 83.09,Wis.Adm. Code <br /> County <br /> .Attach complete site plan on paper not less than B 12 x 11 inches in size. Plan must <br /> include,but not limited to: vertical and horizontal reference point(sM),direction and <br /> poroant slope,Scale or dirnensions,north arrow,and location and distance to nearest road- I.D.x <br /> w of :7-W <br /> APPLICANT INFORMATION- Please print all lntamatlon. Reviewed by Date <br /> Personal i dormatim You provide maybe used for secondary purposes(Privacy law,s.15.04(1)(m)). 5r3�� <br /> Prop Owner Property location <br /> GovL La 1/4 E 1/4,S . T.�q ,N,R �g E(c& <br /> Property Owner's Marling Address Lot ff B Subd.Name or CSM1# <br /> -74.20 509u.^J ul'A <br /> ClY te Zip Code Phone Number ❑ ❑ Vdl&. Town Nearest Road <br /> vg !�'(� 55a c W -3S CD- RP <br /> ❑New Constriction Use: -N%eskiential/Number of bedrooms �y Addition to existing building <br /> RReplacement ❑Public or commercial-Describe: <br /> Code derived daily flow 500 gpd Recommended design loading rate bed,gpd ? _%_-trench,gpd/it2 <br /> Absorption area required _bed,ft2 trench,ft2 Maximum design loading rate - bed,gpd/ft2 _trerrch,gpd1W <br /> nd Recommeed Infiltration surface elevations) q4.'7n ft(as referred to site plan benchmark) <br /> Additional design/site//rconsiderations <br /> Parent material f M n/.r V813T Flood plain elevation,it applicable � ft <br /> S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank <br /> U = Unsuitable for system MS Cl u 0 s ❑ u .5a S ❑ U 0 S ❑ u S ❑ U ❑s E0 11 <br /> SOIL DESCRIPTION REPORT <br /> Boring# F <br /> Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2 <br /> in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. Bed ,Trench <br /> VA <br /> rs 7 8 <br /> 4 ` �`�"� �s .H 1 .7 g <br /> Ground , <br /> %v. <br /> aft. <br /> Depth to <br /> limiting <br /> fagMr <br /> 7 in. <br /> Remarks: <br /> Boring# <br /> Mijt 6 :7 <br /> Ground <br /> elev cud <br /> Kf <br /> ft. ' <br /> Depth to <br /> limiting <br /> factor <br /> in. Remarks: <br /> CST Name (Please Print) Signature Telephone No. <br /> Ium L !S- -4XI <br /> Addfess Date CST Nu ber <br /> 2�'T�o ,3� 1585gt g t�l . -00 2z <br />