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Wisr•.onsin Department of Industry, SOIL AND SITE EVALUATION <br /> Labor and Human Relations Page I of,5 <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 <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/_y�/ Date <br /> Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). �/ <br /> Property Owner n1_ + Property Locati:!"- <br /> Property <br /> n murcc lJ ! 7 <br /> �O M �%•`1�1`,`t t) VP•1r$��l Govt.Lot -t T 1/4,S /✓� T 3�% ,N,R /.� )W <br /> Property Owner's Mailing Address Lot# Block# Subd.Name or CSM# <br /> aloa Avi oar — i --- <br /> City State Zip Code Phone Number Nearest Road <br /> 01n5yo5 ( 61Z )37q- 3785 1:1 City ❑ Village <br /> Rr New Construction Use: [$Residential/Number of bedrooms Z— Addition to existing building <br /> ❑ Replacement ❑Public or commercial-Describe: <br /> Code derived daily flow 300 gpd Recommended design loading rate ! bed,gpd/fl2_ij' trench,gpd/ft2 <br /> Absorption area required 642f bed,n2--3-7.5" trench,ft2 Maximum design loading rate bed,gpd/ft2trench,gpd/ft <br /> Recommended infiltration surface elevabon(s) .0 r ALT 91.$• ft(as referred to site plan benchmark) <br /> Additional design/site considerations A mars amu.1w.0��/JArc is /D~�e f COX ) 1 cSgo SLOiOd S./�p� <br /> Parent material Cr l wd r aa. 412i f Flood plain elevation,if applicable _nt ft <br /> ru <br /> Suitable for system Conventional Mound In-Ground PressureFAT-Graide System in Fill Holding Tank <br /> Unsuitable for system ®S El ❑ s ® u ❑s ® U s !A u ❑ S ® u ❑ S 9 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. (r Bed Trench <br /> I1 4r 7. 3 2- J .9 <br /> 4- T, YQy LF rvr <br /> Ground % -r.SYt241 t ct ' `'1� . 7 .8 <br /> elev. <br /> Depth to <br /> limiting <br /> factor <br /> 910 in. <br /> 88.3, Remarks: �?Lt ;-0 3 /�0" t-r d4 e L 30" i-o li l p" <br /> Boring# <br /> 2- 6-&4sYR.a I.I rn� — a <br /> Ground <br /> ev. <br /> n. <br /> Depth to <br /> limiting <br /> factor <br /> $_&L_in. Remarks: <br /> CST Name (Please PrQEPTIC & EXCAVATION Signa Telephone No. <br /> W28 Court Line Rd. <br /> Address (71 5)835-7482 DateCST Number <br /> rlr�" <br />