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Wisconsin Department of Industry, SOIL AND SITE EVALUATION Pagel of <br /> -Labor and Human Relations <br /> Division of Safety and Buildings in accordance with S. ILHR 83.09, Wis. <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 T"r n e f / <br /> percent slope,scale or dimensions,north arrow,and location and distancetonearest road. Parcel 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)). <br /> Property Owner Property Location <br /> Govt.Lot �, N4-- 1/4,S 3 T I—IC, ,N,R (� E(or <br /> Property Owner's Mailing Address Lot# Block# Subd.Name or CSM# ^_ <br /> City State Zip Code Phone Number Nearest Road r,r a <br /> �S LK),93 (715' ) gUo —x'70 <br /> El ❑ Village Town <br /> k 1-i �{ IC S. J ohn�;o, _ k <br /> New Construction Use: Ip.Residential/Number of bedrooms Addition to existing building <br /> Replacement ❑Public or commercial-Describe: <br /> Code derived daily flow �(.�C. gpd Recommended design loading rate bed,gpd/fiz trench,gpd/ft2 <br /> Absorption area required cx,5 bed,ft2 a 50 trench,ft 2 Maximum design loading rate bed,gpd/fF � 7 trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s) 101 . /a ft(as referred to site plan benchmark) <br /> Additional design/site considerations W /"I1" 5i Ve e.p LaLe nr o i t L/ 1nE[AX`tC <br /> Parent material L �✓ G ! ( f 1 I Flood plain elevation,if applicable �U �i ft <br /> S = Suitable for systemConventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank <br /> U = Unsuitable for system ❑ S ULl S ❑ U ❑ S1%U I ❑ S tAU ❑ S t U ❑ S �Z U <br /> SOIL DESCRIPTION REPORT <br /> Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/f12 <br /> in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. Bed , Trench <br /> '/ �— � J Zm `bl< <br /> � <br /> Ground 3 I I I / K `I S C � . S <br /> elev r <br /> 99,E ft. t 1531 5� '�� c�C� S �pp���S G <'m bl< <br /> al <br /> Depth to <br /> limiting <br /> fac or <br /> Irl in. <br /> Remarks: 7- ��I C' '� <br /> Boring # , 7 '2Y <br /> f' o <br /> 17 <br /> 7' g <br /> q <br /> Ground <br /> Depth to <br /> limiting 1 <br /> fcto ain. Remarks: `,) I I Ate, c r„ r ✓rf�CP` <br /> CST Name (Please Pring Signature // / Telephone No. <br /> Address Date CST Number <br />