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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. <br /> Attach oompiete 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 h G 7 <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. Parcel I.D.# <br /> 0,V10 � 3oZU" t/ - aD <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 OwnerProperty Location <br /> 4i-/e Govt.Lot S ky/1/4 1%e14,S ;2 O T96 ,N,R E(or& <br /> Property Own is Mailing Address Lot# Block# Subd.Name or CSM# <br /> 7,2 �-t <br /> LT A S f 6r 3 /Y0 csM V16 m ss=s6 <br /> City State Zip Code Phone El city ❑-Number rr° Nearest Road <br /> oYt)f L a�e f (�> �) 6 6 it /4Vd `enc <br /> ®New Construction Use: Residential/Number of bedrooms Addition to existing building <br /> ❑ Replacement ElPublic or commercial-Describe: <br /> ,� <br /> Code derived daily now�gpd Recommended design loading rate bed,gpd/if trench,gpd/ft2 <br /> Absorption area required X 7 bed,ft2 trench,ft2 Maximum design loading rate 7 bed,gpd/ft2 trench,gpd/ftz <br /> Recommended infiltration surface elevation(s) 7 J- S9 ft(as referred to site plan benchmark) <br /> Additional design/siteconsiderations / .f— <br /> Parent material 157 4`C ird O! i�/ Flood plain elevation,if applicable ft <br /> S = Suitable for system Conventional MoundIn-GroundPressure AT-Grade System in Fill Holding Tank <br /> U = Unsuitable for system gals- [IU LT S El LTJ s El [✓]�S ❑ U ❑S [9'G- ❑S <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 /> / -9 7,S /S V j / G S 3 vR <br /> 7 Y 5 — s' — r /�t / d s 7 -6' <br /> Ground 7 y s` S O—S ht / OI — -� <br /> elev •� <br /> 95'7 n. �f 7.S f — .S —f <br /> Depth to <br /> limiting <br /> factor ; <br /> > 85C in. // ,y <br /> Remarks:fim"L 678Sfccvr 3 0/ifeo01 �1h uo� Wavy 144&&r IV i 7q <br /> Boring# <br /> M / ds 7 .8 <br /> Ground 'L92 — <br /> os A <br /> elev. <br /> Depth to <br /> limiting <br /> factor <br /> ;�Mn. Remarks: <br /> CST Name (Please Print) n _ Signature Telephone No. <br /> r v <br /> Address ate CST Number <br /> x._98 I'O:/le eh a /f'/ 111le k tP vv. S �y314t 99 rr <br />