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Wisconsin Department of Industry, SOIL AND SITE EVALUATION <br /> Lahor 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 �/.� <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. Parcel I.D.# rp <br /> 090 via / o ! 3m� <br /> APPLICANT INFORMATION- Please print all information. Reviewed ny ' Date <br /> Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). �,J <br /> Property Owner /1 Property Location <br /> 740b QP-r- G� Govt.Lot 5'C,-) 1/4/t)61/4,S,/ T Ye,N,R ,(� E(or' <br /> Property Owner's Mailing Address Lot# Block# Subd.Name or CSM# <br /> a !6 1,Jq3 Ad - - - <br /> City t State Zip Code Phone Number Nearest Road❑ City ❑ Villa a Town Q / � <br /> 6p��N ® fN✓a/ C) <br /> ❑ New Construction Use: Residential/Number of bedrooms -3 Addition to existing building <br /> Replacement ❑Public or commercial-Describe: <br /> Code derived dailyflow �� g g gibed,gpd/ft2 gp <br /> D gpd tt-- Recommended design loading rate o' trench, d/ft2 <br /> Absorption area required bed,ft2J trench,ft Maximum design loading rate bed,gpd/ft'- 4 trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s) / 7 / ft(as referred to site plan benchmark) <br /> Additional design/site considerations <br /> Parent material ST /f C/A C! / Flood plain elevation,if applicable o0lf z!54— ft <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 E s ❑ U H S ❑ U S ❑ U ❑ s <br /> SOIL DESCRIPTION REPORT <br /> Boring# Horizon Depth Dominant Color Mottles Structure GPD/ft2 <br /> Qu.Sz.Cont.Color Texture Consistence Boundary Roots <br /> in. Munsell Gr.Sz.Sh. Bed Trench <br /> > <br /> /1S <br /> -/'h / <br /> Ground 7,5-.P 1 G(- <br /> Depth to <br /> limiting <br /> factQrr <br /> Remarks: <br /> Boring # <br /> 7,5 � % — / 7 <br /> Ground <br /> pe�lev <br /> Depth to <br /> limiting <br /> factor <br /> 7>7in. Remarks: <br /> CST Name (Please Print) Signature Telephone No. <br /> Address c Date CST Number <br />