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Wisconsin Department of Industry, SOIL AND SITE EVALUATION page / of <br /> Labor and Human Relations <br /> Division of safety and Buildings in accordance with s. ILHR 83.09,Wis. <br /> Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must <br /> County <br /> include,but not limited to: vertical and horizontal reference point(BM),direction and 3 JRij e T T <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 O <br /> Personal Information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). 7- <br /> Property Owner Property Location <br /> \3014 N EM Govt.Lot ,g W* fpt,S / T d10.N,R /,5'i(or)w <br /> Property Owners Mailing Address Lot# Block# subd.Name or CSM# <br /> AM 45 IGTDr�RIA R <br /> / state Zip Code Phone Number Nearest Road 57,2? <br /> city <br /> M6ND0171 �6 IJ 5511$ ) E] City [I Village �c;Zrncca Loons LAKE QD <br /> ew Construction Use: Residential/Number of bedrooms z Addition to existing building <br /> Replacement ❑Public or commercial-Describe: <br /> Code derived daily flow y300 gpd Recommended design loading rate bed,gpd/fl2 trench,gpd/ft2 <br /> Absorption area required bed,n2 trench,n2 Maximum design loading rate bed,gpd/fF trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s) 9Z T n(as referred to site plan benchmark) <br /> Additional design/site considerations &&A& /S nuuon)D V A 75 OA6WA4. 94116 DA719r1 a-/d_ <br /> Parent material Flood plain elevation,if applicable tt <br /> S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank <br /> U = Unsuitable for system ❑ s ❑ u ❑ s ❑ u ❑ s ❑ u ❑ s El u ❑s ❑ u ❑ s El 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 /> A o- as a �Z 1115 — - - - z •8 <br /> 4- zs Ya -d- s - - - - -7 a <br /> Ground C 25 R /�' -4' S — — — .'j .8 <br /> elev. — — — uP 0 <br /> 26—b. 2. 76 kA <br /> Depth to <br /> a P /5 YR F I F SYR SSB &11 — — — �P �P <br /> limiting <br /> factor <br /> _&LIn. <br /> Remarks: <br /> 1 - F'L ✓6RIFrcA7-r0A1 of Sof[, k S� 6uorvaro.J dY Qf7l�iilLld <br /> Boring# DA <br /> 610 -1$•4 hFbba-M 'S T11A TEST' k1crD <br /> nitG[ , 16N'r or MON F T Ro 0. uI &V4 9[3 r6 <br /> /c rAc"T' T (644Y of u,A , R1 I CAW od- 76 <br /> Ground AGLA f-IJT cl7 lU IELO ETa)6&j u56 ST A406 <br /> elev. U o ,a s 8 7b FiA1G s r etc a <br /> n. <br /> tuLUU N v" '56-r-6 FI&M L!J S N <br /> Depth to <br /> limiting <br /> factor <br /> _in. Remarks: <br /> CST Na a (Please Print) Signature Telephone No. <br /> It C' �. ao 7�S,25S z <br /> Address F3 � <br /> "I � CST Number al�� <br /> 'e33o t3aaEp_ 'Lmc Rapefl, G{�Ea�� wr � ri 1!/ <br />