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wisconsio'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 C2L4 <br /> include,but not limited to: vertical and horizontal reference point(BM),direction and /.fie <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. Parcel I.D.# <br /> / rZ y� SO /v poo <br /> APPLICANT INFORMATION- Please print all information. Reviewed by Date/e O <br /> Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). <br /> 1 11 <br /> Property Owner t Property Location <br /> KLA) Govt.Lot lyW 1/454,1 1/4,S :3 T y0 ,N,R /S E(o <br /> Property Owner's Mailing Address Lot# Block# I Subd.Name of G M# row <br /> /oo GJ, /W,4-,.A yf/ - <br /> City State Zip Code Phone Number ❑ City ❑l��Village ®' Town Nearest Road <br /> 7e L Aker 4.1 53/8/ l947 )S 77-9x32 SAc /�so.J e e r .4jli <br /> New Construction Use: 2 Residential/Number of bedrooms Addition to existing building <br /> Replacement ❑Public or commercial-Describe: <br /> Code derived daily flow SD gpd Recommended design loading rate . 7 bed,gpd/ft2/trench,gpd/ft2 <br /> Absorption area required jl c/ bed,ft2 Sbp3 t/rench,ft2 Maximu design loading rate 7 bed,gpd/ft2 trench,gpd/ft2 <br /> Recommended infiltration surface elevations) /SCa /9e 4Cef`e--- � 9 y,l(as referred to site plan benchmark) <br /> Additional design/site considerations <br /> Parent material CS 14 G/',+ / r t t <br /> Flood plain elevation,if applicable <br /> S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank <br /> U = Unsuitable for system Cgs El ®S ❑ U KS EJU 9.s El E25,6 ❑ U ❑S ®.0 <br /> SOIL DESCRIPTION REPORT <br /> Boring # Horizon Depth Dominant Color Mottles Structure GPD/ft2 <br /> in. Munsell Qu.Sz.Cont.Color Texture Gr.Sz. Sh. Consistence Boundary Roots <br /> // Bed Trench <br /> _0_T 7,5Yef /S fb� /' ��` -moo <br /> ` <br /> 61C <br /> Ground 7•S`,iP <br /> +n <br /> ele . <br /> ��ft. , <br /> Depth to <br /> limiting <br /> factor <br /> 7 in. <br /> Remarks: <br /> Boring# <br /> Ground <br /> elev. <br /> �ft. <br /> Depth to2 <br /> limiting <br /> fact r <br /> >YY Remarks: <br /> CST Name/(Please Krint) ' 1 Signature Telephone No. / <br /> /f01 <br /> Ad5�ress 1 Date CST Number <br /> ,Uox `a_ t,�/ / - ,u a,:?—.rte[560 .276 / l <br />