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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. 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. <br /> Parcel I.D.# <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.o4(1)(m)). <br /> Property/Owner Property Location rh( <br /> Y BERNit Govt.Lot 1/4 1/4,S 2 T N,R 6 E(o W <br /> Property Owner's Mailing Address Lot# Block# Subd.Name or CSM# <br /> 2-4-7.3 133 R° AV ., 7 Z JE K �SrAT�s <br /> city State Zip Code Phone Number ❑ Ci b ❑ Village Town Road <br /> p <br /> OA 46 1 L11 n1 co uj -S-r- <br /> New Construction Use: LN Residential/Number of bedrooms Z- Addition to existing building <br /> Replacement � EJ Public or commercial-Describe: <br /> Code derived daily flow 300 gpd �7S Recommended design loading rate bed,gpd/f? .c$ trench,gpd/ft2 <br /> Absorption area required bed,ft2 3pp II!'' trench,ft2 /� Maximum design loading rate -� bed,gpd/ftp ` 4 trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s) 1 T•4 Q I s--S ft(as referred to site plan benchmark) <br /> Additional design/site considerations <br /> Parent material (I LpG(AL D/Z(FT Flood plain elevation,if applicable �/ _ft <br /> S Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill rEl <br /> lding Tank <br /> U = Unsuitable for system S U X S E] U KS ❑ U �S ❑ U ®S El S ,BO U <br /> SOIL DESCRIPTION REPORT <br /> Boring# Horizon Depth I Dominant Color Mottles Structure <br /> Texture <br /> in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. Consistence Boundary Roots GPD/ft2 <br /> Bed Trench <br /> / Cs 2„� .' .4 <br /> b ��- MS oMs <br /> �eleyand <br /> Depth to <br /> limiting <br /> f ctor <br /> 7 Win. <br /> Remarks: <br /> Boring # <br /> .,2 2 -3D 7 4 <br /> 0. �- s .-7 4 <br /> Ground <br /> elev. <br /> Depth to <br /> limiting <br /> M7 Min. Remarks: E ,33 <br /> CST Name (Please Print) Signatur Telephone No. <br /> c n Ks /S 6 - S <br /> Addre s Date CPT Number <br /> S AR W1, 5ye -3 6-/1- 7 3K 70 <br />