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Wisconsine Industry, SOIL AND SITE EVALUATION <br /> Labor and Humanuman Relations ORIGIN _ e_of <br /> _ <br /> Division of Safety and Buildings in accordance with s. ILHR 83.09,Wis. Adm. Cod �r/jl�' <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. P I.D.# <br /> 03a -S3 a S- 0� o <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 /> Prope Owner Property Locati n <br /> Govt.Lots(,( 1/4 � 151/4,S 25 T �•{ ,N,R jlp E(or)o <br /> Prope Owner's Mailing Ad ass Lot It Block# Subd.Name <br /> -504+4 Q . Opt- Z � V0If <br /> C Stat Zip Code Phone Number <br /> � ) <br /> El city ❑ Village TOM Nearest Road <br /> New Construction Use: Oesidential/Number of bedrooms Addition to existing building <br /> Replacement ❑Public or commercial-Describe: <br /> Code derived daily flow 1500__gpd Recommended design loading rate bed,gpd/ft2. $ trench,gpd/ft2 <br /> Absorption area required 401 bed,ft2_3[ --trend/�nft2 Maximum design loading rate, 1 bed,gpd/ft2 $ trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s) 9s fa //Ya �/ 2 ft(as referred to site plan benchmark) <br /> Additional design/site <br /> �cco�n�sideratiiolns <br /> Parent material Ka Nr► ►/j�1� Flood plain elevation,if applicable Na ft <br /> S = Suitable for system Conventional rMMound In-Ground Pressure AT-Grade System in Fill Holding Tank <br /> U = unsuitable for system S ❑ U bl S ❑ U '�S ❑ U '�S ❑ U _9 S E3U ❑ S NU <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 /> /s <br /> 8 <br /> z S � � 6 �" i►ts .� .s <br /> Go,o°;'"d 3 7 <br /> oft. <br /> Depth to <br /> limiting <br /> fag r <br /> Z/49 in. <br /> Remarks: 15A &&_ <br /> Boring# <br /> 'QW t /�—� /S S C o 7 g <br /> 3 -3 7 4 r�� Aff All <br /> Ground <br /> v <br /> ft. <br /> Depth to <br /> limiting <br /> factor <br /> ,;� in. Remarks: <br /> CST Name (Please Print) Signature Telephone No. <br /> /tg 6- 457 <br /> Address Date CS umber <br /> 2776o I. zoos <br />