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NAsconsin 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,,.-!r �+ <br /> include,but not limited to: vertical and horizontal reference point(BM),direction and 'V` g l <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. Parcel I.D.# <br /> Dia- Sa�2-6� a®o <br /> APPLICANT INFORMATION - Please print aft information. Reviewed by Date <br /> Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). W17 q-7 <br /> Props Owner Property Location <br /> ORMAW BOLSTRD Govt.Lot 1 tZ 1/4 1/4,S7Zjn ql ,N,R S E(o W <br /> Property Owner's Mailing Address Lot# Block# Subd.Name or CSM# <br /> Z _St4NlPEle LN- <br /> City State Zip Code Phone Number ❑ City El Village 94 Town Nearest Road <br /> APPLP_ VALE � S512y c 12 Z- 2bLY, 90- <br /> ❑ New Construction Use: Residential/Number of bedrooms L- Addition to existing building <br /> XReplacement ❑Public or commercial-Describe: <br /> Code derived daily flow 3W gpd Recommended design loading rate '7 bed,gpd/ft2 •$ trench,gpd/ft2 <br /> Absorption area required 'f2q bed,ft2 7S trench,ft2 <br /> Maximum design loading rate bed,gpd/ft2trench,gpd/fl2 <br /> Recommended infiltration surface elevation(s) ft(as referred to site plan benchmark) <br /> Additional design/siteconsiderations <br /> Parent material OiAoAL Vx FT Flood plain elevation,if applicable ft <br /> S = Suitable for system Conventional Mound In-Ground Pressure IKS <br /> AT-Grade System in Fill Holding Tank <br /> U = Unsuitable for system mS ❑ U 9S ❑ U ®S ❑ U ❑ U rAS ❑ U ❑ S ,® U <br /> SOIL DESCRIPTION REPORT <br /> Boring# Horizon Depth Dominant Color Mottles Structure GPD/ft2 <br /> in. Munsell Qu.Sz.Cont.Color Texture Gr.Sz.Sh. Consistence Boundary Roots <br /> Bed , Trench <br /> t)-5 <br /> 7 <br /> A6 $ <br /> .7 <br /> 2 s-ZS 7•5- <br /> Ground 3 - 3 �— /rts ? . <br /> + elev. <br /> Depth to <br /> limiting <br /> factor <br /> '+ ; <br /> Remarks: tWID twalic .7 mp,% <br /> Boring# <br /> t as K3 z �1-- Hs o�+s dl C 2,► F 8 <br /> Z T_ 5•31 q 14 MSolu d1 u I H .-t 8 <br /> 31-731, iR `-'- MS MS hit {' "I B <br /> Ground <br /> elev. <br /> �Q�•Z..ft. , <br /> Depth to <br /> limiting <br /> ctor <br /> in. Remarks: <br /> CST Name (Please Print) Signature Telephone No. <br /> 177 <br /> IM19jev r7YKl�IS !S- <br /> Address Date CST umber <br /> 2� 1�/EBSM9 . .S (643 -97 300 <br />