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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 <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. Parcel I.D.# <br /> O/.;2 ;-:27 <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 J� Property Location c- <br /> E/0/J j'_5 1J 1�p G Govt.Lot / 1/4 1/4,S;2 3 T Ile ,N,R/_6-- E(oil(W� <br /> Property Owner's Mailing Address Lot# Block# -Soft Name or CSM# <br /> 3a / // .vim 5 5 .2 — 1 V/6 _f <br /> City State Zip Code Phone Number Near%st Road <br /> ❑ City ❑ Village �Town L <br /> -AV C 1R,r.e. v),t- 1 sy76/ 1 ( I ZrAC)t5o j I Ki <br /> ❑ New Construction Use: Residential/Number of bedrooms Addition to existing building <br /> ,Replacement Public or commercial-Describe: <br /> Code derived daily flowgpd _ Recommended design loading rate 7 bed,gpd/ft2__,_,g? trench,gpd/ft2 <br /> Absorption area required bed,ft2 373--trench,ft2 Maximum design loading rate 7 bed,gpd/ft2—e gr trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s) It(as referred to site plan benchmark) <br /> Additional design/site considerations <br /> Parent material CX A4 C Flood plain elevation,if applicable it <br /> S = Suitable for system Conventional rMMound In-Ground Pressure AT-Grade System in Fill Holding Tank <br /> U = Unsuitable for system �S ❑ U 1 S ❑ U 5aS ❑ U 29S ❑ U 1� ❑ U ❑ S S-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. Bed Trench <br /> p`y , RA/� �, .7 <br /> y/ ,s �/y — s n�sdK ¢� ,*7 6 <br /> Ground l`�Q s F �� S l�� f—Cc4 , 7 •p <br /> elev. <br /> Depth to <br /> limiting <br /> tactor <br /> Remarks: <br /> Boring # `S S /_5 mijlk v e 3 =cd <br /> Ya s s is , <br /> Ground <br /> � <br /> ev�/ <br /> /L�1Lft. <br /> Depth to <br /> limiting <br /> factor <br /> 720in. Remarks: <br /> CST Name (Please Print) Signa re Telephone No. <br /> de, leu j B/� FY,9-CST Number <br /> Date <br /> Address f `6o ��74• <br /> Qo �1S r^ ox8'7 y 3 <br />