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Wisconsin Department of Industry, SOIL AND SITE EVALUATION <br /> Labor and Hyman Relations Page of <br /> Division of Safety,and Buildings in accordance with s. ILHR 83.09,Wis. <br /> Attach complete site plan on paper not less than B 1/2 x 11 inches in size. Plan must County <br /> include,but not limited to: vertical and horizontal reference point(BM),direction and 12 <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. Parcel I.D.# <br /> z I 42 <br /> APPLICANT INFORMATION- Please print all information. Revlewed by Date <br /> Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). <br /> Property Owner ,1 Property Location <br /> E ELr'�I R Govt.Lot 1/4 1/4,S T qj ,N,R /6 E(ore <br /> Property Owneeav Mailing Address Lot# Block# Subd.Name or CSM# <br /> U13 �LOW46r_ VIP _ 3 SANNSEN R105KV16W PtgtC <br /> city State Zip Code Phone Number Nearest Road <br /> (z W I 51830 ( <br /> 115 459- O33 ❑ City W j la a Town LQW A E <br /> ❑ New Construction Use: Residential/Number of bedrooms Z Addition to existing building <br /> C Replacement ❑Public or commercial-Describe: <br /> Code derived daily flow 5W gpd Recommended design loading rate '1 bed,gpd/ft2 --% trench,gpd/ft2 <br /> Absorption area required 4Z,0 bed,ft2 3 S tr/emnch,ft2 Maximum design loading rate 1 bed,gpd/ttz •$ trench,gpd/ft2 <br /> Recommended infiltration surface elevaton(s)) ft(as referred to site plan benchmark) <br /> Additional design/site considerations 'r <br /> Flood plain elevation,if applicable /✓f ft <br /> Parent material G WO R L- VKIEl' <br /> Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank <br /> S = Suit"for systemU = Unsuitable for system m S El Os ElU S ❑ U lei S ❑ U S ❑ U ❑ S U <br /> SOIL DESCRIPTION REPORT <br /> Boring# Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2 <br /> in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. Bed Trench <br /> I I K 3 Z S OMs 1 3S Z✓� $ <br /> /its <br /> Ground -3 3.06 S <br /> lev. <br /> 9�ft. <br /> Depth to <br /> limiting <br /> f for <br /> � �in. <br /> Remarks: <br /> Boring# M$ S NI 93 �l •� a <br /> z <br /> 5-;3 -7-SLIR 41q MS l+s d( s M "7 s <br /> 7.5 R 4 6 N S OMS I r- "► 8 <br /> Ground <br /> elev. <br /> IOD3ft• ' <br /> Depth to <br /> limiting <br /> fWgr <br /> 7 ln. Remarks: <br /> 97 <br /> CST Name (Please Print) Signature Telephone No. <br /> Address Date CST Number <br /> 27760 w 3S W�sr�R W1 5 893 <br /> /0 - 73 -176 0 <br />