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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 6a,Q iv t / <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. Parcel I.D.tt <br /> 0 3 D_ 3 -6 a - zo o <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 /> gQE7DICV1456AJ Govt.Lot /✓C 1/4 NNJ 1/4,S a3 T 441 ,N,R E(ore <br /> Property Owner's Mailing Address Lot# Block# Subd.Name or CSM# <br /> (oa STUIC'6E©nl �quE �/. 2,z A-) <br /> City Village Town <br /> City State Zip Code Phone Number Nearest Road <br /> '' I� ❑ ❑ �, <br /> 6(jt3*� CJi 5-q6 r1 ( ?/S— ) WAA6-3A26' I SaJ£ss I 5mrc/fw 35" <br /> ❑ New Construction Use: KResidential/Number of bedrooms iA_ Addition to existing building <br /> Replacement ❑Public or commercial-Describe: <br /> Code derived daily flow gpd 11 Recommended design loading rate _bed,gpd/ft2 •R trench,gpd/ft2 <br /> Absorption area required_yam bed,ft2 7) trench,ft Maximum design loading rate!7 bed,gpd/ftz g trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s) zJ; ft(as referred to site plan benchmark) <br /> Additional design/site considerations <br /> Parent material at4C3e41-c 1_XyGfi Flood plain elevation,if applicable /L)14L ft <br /> S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank <br /> U = Unsuitable for system rVIs ❑ U �(s ❑ U S ❑ U s ❑ U ❑ s Z U ❑S lU <br /> SOIL DESCRIPTION REPORT <br /> Boris # Horizon Depth Dominant Color Mottles Structure GPD/ft2 <br /> Boring in. Munsell Qu.Sz.Cont.Color Texture Gr.Sz.Sh. Consistence Boundary Roots <br /> Bed , Trench <br /> 17 ofoWe �s s6 sM L G S z wX r <br /> �-� 7,5-Yj sof_Z: M 5 S/P M L D I F r <br /> Ground <br /> elev.,r <br /> ft• <br /> Depth to <br /> limiting <br /> factor , <br /> Oin. <br /> Remarks: ? <br /> Boring # <br /> 03 ?r 5 3/l 7(/&7A14'5_ S, — — — — Y <br /> F <br /> Ground <br /> elev. <br /> Depth to <br /> limiting <br /> �factorrj/9� �JU6gZ <br /> sn. Remarks: <br /> CST/Name (Please Print) Si n ure Telephone No. <br /> 756NR�r) <br /> Address Date CST Number <br /> l(0? �2264,70 <br />