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,nsin Department of Industry, SOIL AND SITE EVALUATION <br /> it and Human Relations Page of <br /> nvision 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 URAA57r <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. Parcel I.D.# p <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)). 21 <br /> Property Owner Property Location !� <br /> l-Ime MEY151Z Govt. Lot 1/4 1/4,S32 T� ,N,R 16 E(or& <br /> Property Owner's Mailing Address Lot# Block# Subd.Name or CSM# <br /> 2'74-(01 0nlcoLtJ ST- 'gFFizie5 ESM19s <br /> `city State Zip Code Phone Number <br /> WE$S1�R �I 5t��G�� I ) E) City El Village ® Town Nearest Road <br /> KLAt4P jjj CeO N Sr: <br /> New Construction Use: Residential/Number of bedrooms 2 Addition to existing building <br /> ❑ Replacement N Public or commercial-Describe: <br /> Code derived daily flow 300 gpd Recommended design loading rate ' bed,gpd/f12 •—Strench,gpd/ft2 <br /> Absorption area required bed,It 3?S tre/y��h,ft2 Maximum design loading rate •� bed,gpd/ftz .'$ trench,gpd/ftz <br /> Recommended infiltration surface elevation(s) 9�• /ff� ��v-g ft(as referred to site plan benchmark) <br /> Additional design/site considerations UF7' RE&wn fcX AZT 15�11lS <br /> Parent material &ACIAL DgjjFr Flood plain elevation,if applicable Nl� ft <br /> S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank <br /> U = Unsuitable for system M S ❑ U X 5 ❑ u Ms ❑ U ®S ❑ U 0 S ❑ u ❑ S •RJ U <br /> SOIL DESCRIPTION REPORT <br /> Boring# Horizon Depth Dominant Color Mottles Structure GPD/ft2 <br /> in. Munsell Qu.Sz.Cont.Color Texture Gr.Sz.Sh. Consistence Boundary Roots <br /> Bed Trench <br /> M5 Pwk M1 CS 2J '► . ,Q <br /> 2 5- 7S fz 4 4 �— NS d 15 M I le o 7 4 <br /> Ground 7 4 �— /45 PDMS 1-11 '-1 lM 7 ,.$ <br /> e .$ft. <br /> Depth to <br /> limiting <br /> factor <br /> 9 S-7 in. <br /> Remarks: <br /> Boring # <br /> f LS FZ32 t— N3 .- ' -L <br /> Z <br /> 7-S A 4 - .8 <br /> 5vti <br /> Ground <br /> elev. <br /> Depth to GG4 f� �+ <br /> limiting GG1 J <br /> I JY <br /> fa? in. Remarks: IAA'V-* 4094 �, <br /> CST Name (Please Print) - Signature Telephone No. <br /> c RD o n/S �/S-866- X157 <br /> Address Date CST Number <br /> 27760 /� 3S y,}151557 z Vil . SIMS? 7_1- fl o <br />