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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 w/t v <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. parcel I.D.# <br /> L76909 /00 �3o v <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 P�- <br /> /` C 4— y Govt.Lot 1/4 1/4,S�j T yo ,N,R /y E(or)� <br /> Property O is Mailing Address Lot# Block# Subd.Name or CSM# <br /> Z941 yg .3 1 1M 5'c oln L K Shores <br /> City State Zip Code Phone Number ❑ City ❑ Village Town Nearest Road <br /> S/�itla� oni c V10, 12s07A (dao ir.�r-ss3 c-07`t �AIT c.v n L <br /> ❑ New Construction Use: Residential/Number of bedrooms Addition to existing building <br /> fi ,Replacement ❑Public or commercial-Describe: <br /> Code derived daily Bow-3o 0 gpd '7 Recommended design loading rate 4 7bed,gpd/ft2 z d�trench,gpd/ft2 <br /> Absorption area required-W-bed,ft25/ trench,ft2 Maximum design loading rate ,� /ft2 iO bed,gpdtrench,gpd/ft2 <br /> Recommended infiltration surface elevation(s) qS�J� ft(as referred to site plan benchmark) <br /> Additional design/site considerations <br /> Parent material �rfiSZC iA (�/�/ J� <br /> Flood plain elevation,if applicable /S,�f}' ft <br /> S = Suitable for system Conventional Mound In-Ground Pressure AT <br /> I/-Grade System in Fill Holding Tank <br /> U Unsuitable for system � El ❑ U A-6 El1.98 ❑ U 59-s ❑ U ❑ S MU <br /> SOIL DESCRIPTION REPORT <br /> Boring # Horizon Depth I Dominant Color MottlespGr. <br /> tructure GPD/ft2 <br /> Consistence Boundary Roots <br /> in. Munsell Qu.Sz.Cont.Color Sz.Sh. Bed Trench <br /> Ground <br /> elev. <br /> fit. 7.52! ;;_e;*' <br /> Depth to <br /> limiting <br /> factor <br /> Remarks: <br /> Boring# <br /> .8' <br /> Ground ' 'AX /Jf r , s .� <br /> elev. <br /> Wit. <br /> Depth to <br /> limiting <br /> factor <br /> kin. Remarks: <br /> CST Name (Please Print Signature Telephone No. <br /> 1_4e)An4M— az <br /> Address Date CST Number <br /> 5,A- .5-1 Sifc.J GJ.� .s5' 7� il' - 6 -av <br />