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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 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 a y/"v <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. Parcel I.D.# <br /> oaY .3 as o / moo <br /> APPLICANT INFORMATION- Please print all information. Reviewed by Dale y <br /> Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). <br /> Property Owner Property Location �l <br /> AIL) ,,--r; Govt.Lot 2 5,,�1/4,V(,/1/4,S a a T 3 9 ,N,R /y E(or) v� <br /> Property Owner's Mailing Address Lot# Block# Subd.Name or CSM# <br /> City State Zip Code Phone Number Nearest Road <br /> S 00A) o ❑ City Village ®' Town ton7 c <br /> i <br /> ❑ New Construction Use: esidential/Number of bedrooms � Addition to existing building <br /> �Fieplacement Mublic or commercial-Describe: '— <br /> Code derived daily flow VSO gpd Recommended design loading rate 1 7 bed,gpd/ft2__L_?trench,gpd/ft2 <br /> Absorption area required Abad,n2S�trench,n2 Maximum design loading rate , 7 bed,gpd/f12 18 trench,gpd/ft2 <br /> Recommended infiltration surface elevabon(s) 96,3r it(as referred to site plan benchmark) <br /> Additional design/site considerations '1 <br /> Parent material �' /A-c//g Flood plain elevation,if applicable /L A- 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 Ins ❑ U cgs ❑ u 3 S ❑ u 0 S ❑ u ❑ s ® U <br /> SOIL DESCRIPTION REPORT <br /> Boring# Horizon Depth Dominant Color Mottles Structure Consistence Boundary Roots GPD/ft2 <br /> Texture <br /> in. Munsell Cu.Sz.Cont.Color Gr.Sz.Sh. Bed Trench <br /> o-Y 7-s <br /> e2 6 7,-)ZITO 676 — / /nis6K ,)Fr c S 3F<o , 8 <br /> Ground 6-/f6 7,3 q ��l $ O52 /n S 3f 8 <br /> ,glIQv. <br /> *-2e <br /> � <br /> *-7 <br /> Depth to <br /> limiting <br /> factor <br /> Remarks: <br /> Boring# <br /> ©-,/ % dr'!�- C .5 -co P <br /> a ag 7,� if — /S 11n yZrhdf� �s '. .8 <br /> sp/l it <br /> Ground y$�/ S <br /> elev. <br /> 9�n. <br /> Depth to <br /> limiting <br /> fAFtor U�j 's/ <br /> 7-EY—in. Remarks: b <br /> CST Name (Please Print signature Telephone No. <br /> w/y� loS-X'e)X L L/ a33,-9-2_2PZ <br /> Address Date CST Number <br /> .Qox Siy S��e�J !�✓ SyP�,2 6-5-9� 9�8� <br />