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in accord with ILHR 83.05,Wis.Adm. Code
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<br /> -site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include,but f 4'A. C'
<br /> vertical and horizontal reference point(BM),direction and%of slope,scale or PARCEL l.D.# 03v- ;of -O ZGi o
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<br /> nod, north arrow,and location and distance to nearest road. G' ,� /SG! _ Ot>
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<br /> LICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE
<br /> PROPERTY OWNER • -c://e-4%.5-e., )
<br /> � PROPERTY LOCATION
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<br /> ~PROPERTY OWNER':S MAILING ADDRESS LOT# I BLOCK# I SUBD.NAME OR CSM#
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<br /> "' STATE ZIP CODE PHONE NUMBER DOTY QV,ILLAGE MOWN !NEAREST ROAD
<br /> . r ,,,,F //, ,1) SSY3 q (biz) 78S- 'S567 -7,12d4- K 44'4" c✓17,3,0iX,.Ni 4447 OK,
<br /> 4 New Construction Use' Residential/Number of bedrooms j ] Addition to existing building
<br /> I Replacement ? Public or commercial describe
<br /> '�ctfe derived daily flow 5 oD_gpd Recommended design loading rate - 5- bed,gpd/ft2 • 6 trench,gpd/ft2
<br /> Absorption area required (c bed,ft2 .3 aO trench,ft2 Maximum design loading rate -.45- bed.gpd/ft2 a 49 trench,gpdfft2
<br /> Recommended infiltration surface elevation(s) 28. / ft (as referred to site plan benchmark) /
<br /> Additional design i site considerations /a ' -4' .7a - c/7/?-4.Al a Tz' cv4'Cd ie y. 3
<br /> parent ma:erial Flood plain elevation,if applicable ft
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<br /> I S=Suitable for system I ^ONVENTIONAL I MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL I HOLDING TANK
<br /> I U=Unsuitable for system I S DU ; ZS DU l Q S ❑U ill S D U 0 S ZU ; 0 S 6�t1
<br /> SOIL DESCRIPTION REPORT
<br /> Depth Dominant Color Mottles Structure 1 Consistence 1 GPD/ft2
<br /> i'orir* # Horizon I Texture Barclay Roots
<br /> q f .n. Munsell Qu.Sz_Cont Color Gr. Sz. Sh. ' ; Bed Trench
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<br /> Signature �� C Date: CST N mbar
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