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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 B 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. Pa el 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.15.04(1)(m)). <br /> PropertyProperty tion <br /> . J0.VWRRVeN Govt.Lot.5 1/4 1/4,S ,3 Tqj ,N,R l6E(oQ' <br /> Property Owners Mailing Address Lot# Block# Subd.Name or CSM# <br /> 1072 AaDhl <br /> City State Zip Code Phone Number Near st Ro d <br /> ❑ Ciiy Village Town <br /> JILNew Construction Use: IgResidential/Number of bedrooms -3 Addition to existing building <br /> ❑ Replacement ❑Public or commercial-Describe: <br /> Code derived daily flow gpd Recommended design loading rate <br /> _2.? bed,gpd/fl2 g trench,gpd/ft2 <br /> Absorption area required (n 3 bed,'ft2 50 tryfich,ft Maximum design loading rate -7 bed,gpd/fl2 •g trench,gpd/tt2 <br /> Recommended infiltration surface elevation(s) a 1. AIS- q I.O ft(as referred to site plan benchmark) <br /> Additional design/site considerations <br /> Parent material 1a2►Fr Flood plain elevation,if applicable 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 YS ❑ u �s ❑ u Xs ❑ u ❑s J$u <br /> SOIL DESCRIPTION REPORT <br /> Boring# Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/112 <br /> In. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. Bed Trench <br /> 1 2 �— MS ? 8 <br /> Ground G �- .7 <br /> R <br /> ft. <br /> Depth to <br /> limiting <br /> factor <br /> Remarks: a, ND AL11a <br /> Boring# ,�v� .? , •$ <br /> t �-� <br /> 2 <br /> 3—` •------ Ms Ms ' <br /> Ground <br /> elev. _ . <br /> 91�Zft. <br /> Depth to <br /> limiting <br /> fq&r <br /> 7 n. Remarks: <br /> CST Name Please Print) Signature Telephone No. <br /> tH R a Kim /S- <br /> Address Date CST Number <br /> ��?60 � <br /> 3s- 34 70 <br />