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'Wisconsin Department of Industry, SOIL AND SITE EVALUATION <br /> Labor and Human Relations R I G I N A Le of <br /> `Division of Safety and Buildings in accordance with s. ILHR 83.09, Wis. Adm. <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. Pa el I.D.# <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)). ld —15 <br /> Property Owner Property Location <br /> I <br /> Il Govt.Lot 4U 1/4 dr 1/4,S 2S T41 ,N,R 17 E(or)I <br /> Property Owner's Mailing Add ss Lot# Block# Subd.Name or CSM# <br /> 1lo5' 144 I ACES <br /> City State Zip Code Phone Number Nearest Road <br /> pLJ W1 "A'930 ( �`J )(o�r7 ❑ City-S%415Village Town 7 <br /> New Construction Use: Residential/Number of bedrooms Z Addition to existing building <br /> Replacement ❑Public or commercial-Describe: <br /> Code derived daily flow 300 gpd Recommended design loading rate bed,gpd/ft2 -—Strench,gpd/ft2 <br /> Absorption area required 4za bed,ft2 3-K trench,ft2 Maximum design loading rate bed,gpd/ft2 - 00 trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s)) ft(as referred to site plan benchmark) <br /> Additional design/site considerations <br /> Parent material G IX C 1 A L -PRJVT Flood plain elevation,if applicable Na ft <br /> S = Suitable for system �Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank <br /> U = Unsuitable for system Ik S ❑ U W S ❑ U Xs ❑ U Us ❑ U ® S ❑ U ❑ S r,�?U <br /> SOIL DESCRIPTION REPORT <br /> Boren # Horizon Depth Dominant Color Mottles Structure GPD/ft2 <br /> 9 Texture Consistence Boundary Roots <br /> in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. Bed , Trench <br /> -S -5,q)2 <br /> 2 a-14 7.5 6 �� Is •7 ; .9 <br /> Grround5 14-40 5 4/4 MS u f ? . <br /> 20 <br /> n. 4 S <br /> Depth to <br /> limiting <br /> fa or <br /> in. <br /> Remarks: <br /> Boring # <br /> 7 5/1, <br /> 2 2 - 754A 6 <br /> -1 4 <br /> Ground A 44,78 <br /> II' � wry <br /> n. <br /> q& - <br /> Depth to <br /> limiting <br /> factor <br /> Min. Remarks: <br /> CST Name (Please Print) Signature Telephone No. <br /> 0414A90o - 467 <br /> Address Date CST Number <br /> 2--7-7lo0 ' S 1n�E8sf i4 �1-. ($ 3 D- 22 <br />