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as 333 <br /> Wisconsin Department of Industry, SOIL AND SITE EVALUATION �erMl4_4 <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 L <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. Parcel I.D.# <br /> APPLICANT INFORMATION- Please print aq information. Reviewed by Date <br /> Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). <br /> Pr arty Owner Property Location <br /> rO^j f} /U de >° Govt.Lot 540 1/4 AAV 1/4,S T 1.16 ,N,R f � E(o W <br /> Property Owner's Mailing Address / Lot# Block# Subd.Name or CSM# <br /> B 60 c1�y e-/U2., e- <br /> city <br /> ie,City State Zip Code Phone NumberNearest Road <br /> ❑ City El village Town < <br /> swo �3 �as-5` S e, a. <br /> ❑ New Construction Use: -Residential/Number of bedrooms _ Addition to existing building <br /> Replacement ❑Public or commercial-Describe: —� <br /> Code derived daily flow Ys^v gpd / Recommended design loading rate . *2bed,gpd/ft2 g trench,gpd/ft2 <br /> Absorption area required Z `` bed,ft2 J Z trench,ft2 Maximum design loading rate t 7 bed,gpd/tt2 trench,gpd/ft2 <br /> Recommended infiltration surface elevabon(s) e� ft(as referred to site plan benchmark) / <br /> Additional design/site considerations Q /O <br /> u &Y): o ram C�Blec k a/o.js4-:J ? �/ <br /> Parent material Flood plain elevation,if applicable ir/.¢ ft <br /> S = Suitable for system Conventional Mound In-Ground Pressure AT-GradeSystem in Fill Holding Tank <br /> U = Unsuitable for system El ❑ U ❑ S ElU ❑ S ❑ U ❑ S ❑ U ❑ S ❑ U ❑ S ❑ U <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 tic Sz.Sh. Bed , Trench <br /> a <br /> Ground <br /> elev. <br /> Depth to <br /> limiting Ah <br /> factor <br /> )Z5/in. <br /> Remarks: <br /> Boring # <br /> Ground <br /> elev. <br /> n. <br /> Depth to <br /> limiting <br /> factor <br /> in. Remarks: <br /> CST Name (Please Print) Signature Telephone No. <br /> Grp /fit 5/la 11V7 w a-or�l Y9-7a�� <br /> Address Date CST Number <br />