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Wisconsin Department of Industry, SOIL AND SITE EVALUATION- <br /> Labor and,Humah 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 <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. <br /> Parcel I.D.# <br /> APPLICANT INFORMATION- Please print all information. Reviewed by 3 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 /> /✓1 t^,i G/j Govt.Lot 74J 1/4A/4J 1/4,S_:73 T39 ,N,R J ? E(or(o <br /> Property Owner's Mailing Address Lot# Block# Subd.Name or CSM# <br /> _5-0'!a -So- S,9/`sF�o f} -- r — <br /> city DA State ZipCode <br /> / Phone Number ❑ Cit/y ❑ Villa e_ l Town Nearest Road )/�) <br /> I /i/� JJ//1O (62 k - y9� f--��.JC .0 �or �l�r V <br /> ® New Construction Use: Residential/Number of bedrooms _ Addition to existing building <br /> ❑ Replacement ❑Public or commercial-Describe: <br /> Code derived daily flow yS0 gpd Recommended design loading rate 1 bed,gpd/ft2 . b trench,gpd/ft2 <br /> Absorption area required �040 bed,ft2 .s"a trenc,h. ft2 Maximum design loading rate bed,gpd/ft? .r � trench,gpd/ft2 <br /> 9 4y <br /> Recommended infiltration surface elevation(s) .$ ft(as referred to site plan benchmark) <br /> Additional design/site considerations '/— lee A AC W_N_j 9?.S Q f}j c e- !t <br /> Parent material 42AQC i /OY/`% ?I—,7 1Flood plain elevation,if applicable /7/1'4— ft <br /> 5 = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank <br /> U = Unsuitable for system (( $$ ❑ U ❑ U �,S ❑ U Xs ❑ U ❑ U ElS <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 /> O- 7..$).P35 sG v{� Seo i <br /> Ground <br /> elev. <br /> 77,A <br /> Depth to <br /> limiting <br /> factor <br /> J"�Qin. <br /> Remarks: <br /> Boring# <br /> 9,47, WV <br /> 15 <br /> Ground <br /> elev. <br /> Depth to <br /> limiting <br /> f ctor <br /> � in. Remarks: <br /> CST Name (Please Print) Signature Telephone No. <br /> a4d e- R GJ c,-7Y9-7;2946' <br /> ,-7Y9-7;29G <br /> Address Date CST Number <br /> 6J.;t- -Y-/-do -22769'/ <br />