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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. Adm. Code <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 �4/•Nff <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest 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 1/4 114,S14 T Y6 ,N,R l&' E(ore <br /> Property Owner's Mailing Acrdress Lot# Block# Subd.Name or CSM# / <br /> /.? /O J� /0 Ah q-. c>S�i o e S <br /> City State Zip Code Phone Number <br /> �« � �� T y��7 ( ) ❑ City El ® Town Nearest Road <br /> L <br /> New Construction Use: MIResidential/Number of bedrooms Addition to existing building <br /> Replacement ❑Public or commercial-Describe: <br /> Code derived daily flow SJ gpd Recommended design loading rate bed,gpd/n2�p trench,gpd/ft2 <br /> Absorption area required 6y3 bed,ft2 ��trench,n2 Maximum design loading rate_7 bed,gpd/tt2 i trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s) 9 3_ h'014ce'02aJ 9 it(as referred to site plan benchmark) <br /> Additional design/site considerations <br /> Parent material G/RC iA �Pi IC7� Flood plain elevation,if applicable Z&/A— it <br /> S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank <br /> U = Unsuitable for system XLS ❑ U KS ❑ U 0 S ❑ U MS ❑ U ❑ S 9u <br /> SOIL DESCRIPTION REPORT <br /> Boring # Horizon Depth Dominant Color Mottles Structure GPD/ft2 <br /> Texture Consistence Boundary Roots <br /> in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. Bed , Trench <br /> .. / <br /> 0-7 7, -- l 5 dam- c s <br /> 7-1 <br /> Ground Y �S X <br /> ��Ln. <br /> Depth to <br /> limiting <br /> factor <br /> >jpqin. <br /> Remarks: <br /> Boring # <br /> / 0-7 '7,5_0 6it �S {5-o <br /> .syr <br /> 7,5yR 5;V <br /> Ground <br /> elev. <br /> oJ5 fin. <br /> Depth to <br /> limiting <br /> facto <br /> tin. Remarks: <br /> CST Name (Please Print) Signature Telephone No. <br /> zevAclt� Ru tio/ W4t-0'& 5'9--7 <br /> Address , Date CST Number <br /> C:b <br />