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Wisconsin Department of Industry, SOIL AND SITE EVALUATION <br /> Labor and Humeri Relations Page of <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 County <br /> include,but not limited to: vertical and horizontal reference point(BM),direction and �� e <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. Parcel I.D.O <br /> Cl R -011,_0�n <br /> APPLICANT INFORMATION- Please print all information. Reviewed by 2 Date <br /> Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). 'a'�-C4- <br /> Property <br /> C4-Property Owner Property Location <br /> Chuck Brookshaw Govt.Loq\ 1/4,S 211 T 39 ,N,R 16 kX(or)W <br /> Property Owner's Mailing Address Lot a Blockfi Subd.Name or CS <br /> 6028 Devils Lake Road N 20 ac. N 1/2 SW 1/4 <br /> City State Zip Code Phone Number Meenon Nearest Road <br /> Webster I 54893 I ) ❑ City ❑ Village FXI Town St. Hwy. 35 <br /> ® New Construction Use: [j Residential/Number of bedrooms 1 Addition to existing building <br /> ❑ Replacement ❑Public or commercial-Describe: <br /> Code derived daily flow 150 gpd Recommended design loading rate—_Zb d,gpd/fl2___S_trench,gpd/ft2 <br /> Absorption area required 215 bed,tt((211 187.5 trench,ft2 Maximum design loading rate -7 b d,gpd/ft2 -8 trench,gpd/tf2 <br /> Recommendinfiltrationsurface— ingroudsd pressure — ft(as referred to site Ian benchmark) <br /> Additional design/site considerations <br /> Parent material Glacial Drift Flood plain elevation,if applicable NA it <br /> S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank <br /> U = Unsuitable for system ® s ❑ u IDS ❑ u �7 s ❑ u KI s ❑ u ® s ❑ u ❑ S ® u <br /> SOIL DESCRIPTION REPORT <br /> Boring # Horizon Depth Dominant Color Mottles Structure GPD/ft2 <br /> Texture Consistent Boundary Roots <br /> in. Munsell Du.Sz.Cont.Color Gr.Sz.Sh. Bed ,Trench <br /> 1 1 0-59 r 7.5 YR 5/6 --------- is lmsbk mvfr gs 3f–co .7 .8 <br /> 2 i9"-6V7.5 YR 5/4 c2d 5 YR 5/8 fs lmsbk mfr -- — NA NA <br /> Ground <br /> elev. <br /> 98.4 n. <br /> Depth to <br /> limiting <br /> '594r <br /> in. <br /> Remarks: <br /> Boring# <br /> 1 –59" 7.5 YR 5/6 -------- 11 <br /> 2 5 "-66 7.5 YR 5/4 c2d 5 YR 5 8 fs -- -- NA KA <br /> Ground <br /> OV4 ft. <br /> Depth to <br /> limiting <br /> " In. Remarks: Xa b�g <br /> CST Name (Please Print) Signature J , // Telephone No. <br /> Wade Rufsholm (715) 349-7286 <br /> Address Date CST Number <br /> 24702 Lind Road P.O. Box 514 Siren,Wl 54872 10/18/95 3583 <br />