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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 complete site plan on paper not less than 81/2 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. Parcel I.D.# <br /> ov0 .3 —D8 <br /> APPLICANT INFORMATION- Please print all information. Reviewed byy�/ Date <br /> Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). � &k 7/71 <br /> Property Owner ^� Property Location C1. 'in . <br /> I 1 T , I fl n Govt.Lot (� #J4— 1/4,S 3 T y(> ,N,R E(ore <br /> Property Owner's Mailing Address Lot# Subd.Name or CSM# <br /> 5• �o{ nso t:ke P —A­Block* <br /> city State Zip Code Phone Number Nearest Road Firc a a 8195 <br /> V)Cb5f�( WZ "93 (715 ) 966 —W30 ❑n city ❑ v_ \town 5. 10650 )ed. <br /> ❑ New Construction Use: Residential/Number of bedrooms Addition to existing building <br /> Replacement ❑Public or commercial-Describe: <br /> Code derived daily flow -0�f0�gpd Recommended design loading rate 7 bed,gpd/n2 ' g trench,gpd/n2 <br /> Absorption area required gibed,n2 d50 trench,n2 Maximum design loading rate bed,gpd/ft2 • g trench,gpd/ft2 <br /> i <br /> Recommended infiltration surface elevation(s) )O /a n(as referred to site plan benchmark) <br /> Additional design/site considerations W nod ed S;fc r[e�kt ce m e f j It 41 ry)yLt nd <br /> Parent material G(a c is �rI- I Flood plain elevation,if applicable N n <br /> S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill HoldingTank <br /> U = Unsuitable for system El U %S El U El U ❑ S 1AU ❑ S tAU El IZ[U <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 /> 2 f (- mvfr 3f-co . 7 �S <br /> E-k, 7,_E l m s 6K mvfr Qs ;-F-co , 7 <br /> Ground 3 I(o-i`� 5y �y� Sc o� YY3{-co �� s <br /> 9yel. n. 193 S 1 <br /> �f n `'IcnS�f$ CGY1�nf <br /> Depth to 36-7.Z 1 F– I C eZCt T F S/g' �"1 5 M YhUTr <br /> limiting <br /> fa.ct�o,r <br /> /tIn. <br /> Remarks: i <br /> Boring# <br /> 1 o-to 7,s` 93/a 15 c5 3f 7 ; ,8 <br /> 13a6- )7 5, f 2 /S4 - r5c JMS nVfr g y _7, <br /> ?ms ,k mfr 34�'w g <br /> Ground q a-3 5 L41 C/ C d S`I ksl8 C rnsbK ,/nfr <br /> 1 f•fit. ; <br /> Depth to <br /> limiting <br /> factor #3 sr F U P <br /> o�in. Remarks: <br /> CST Name (Please Print Signature Telephone No. <br /> Iry <br /> Addresses r Date CST Number <br />