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Wisconsin 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. <br /> Attach complete site plan on paper not less than 6 1/2 x 11 inches in size. Plan must County <br /> include,but not limited to: vertical and horizontal reference point(BM),direction and ,fOIZN E77- <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 , _ iy Date <br /> Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). C��L <br /> Property Owner Property Location <br /> '.A'CTcr/L. /Zo/!!r/q/✓ Govt.Lot £3 1/4 1/4,S /6 T 38 ,N,R /¢ (or)W <br /> Property Owner's Mailing Address Lot# Block# Subd.Name or CSM# <br /> J B z o n covNry /2D 1p 13 C 5m Yo/- , Is' O, 31 <br /> City State Zip Code Phone Number Nearest Road 0.4 7z1i'cF S, <br /> PLymouTii /r9 A/ 56-4¢.7 ( 6/Z ) ¢7 6339 El city El village � Town LyKG /�icK! c/.v/w/0' <br /> N ,c} <br /> ❑ New Construction Use: ❑Residential/Number of bedrooms Addition to existing building <br /> ❑ Replacement ❑Public or commercial-Describe: <br /> Code derived daily flow gpd Recommended design loading rate bed,gpd/ft2 trench,gpd/ft2 <br /> Absorption area required bed,ft2 trench,ft2 Maximum design loading rate bed,gpd/ft2 trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s) ft(as referred to site plan benchmark) <br /> Additional design/site considerations <br /> Parent material Flood plain elevation,if applicable A//-f 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 ❑ S ❑ U ❑ S ❑ U ❑ S ❑ U ❑ S ❑ 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 /> N cN v L y <br /> $'y/a. 3/L /✓ONCz 6-'G- /40W L� mr% P / Nr� <br /> z 58 7,5-y/2, 419_ 1'1e ,e cos o <br /> Ground <br /> elev. <br /> Depth to <br /> limiting <br /> factor <br /> 7n. <br /> Remarks: <br /> Boring# <br /> 13 <br /> Ground <br /> elev. <br /> ft. ' <br /> Depth to <br /> limiting - <br /> factor ._ <br /> _in. Remarks: <br /> CST Name (Please Print) Signature Telephone No. <br /> ji�om yf C, Sw�n/Jo•✓ /� r� 2e�/�7t /5- _3V-9 Z <br /> Address Date CST Number <br /> 21t-996 36- SSV-87Z_ S a 0 Z/6-3 <br />