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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 andu9-,c'[' <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. Parcel I.D.# <br /> 32 9350 01 600 <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 /> Property Owner Property Location <br /> OYD OTj4V Govt.Lot 1/4 1/4,S j& T 4) ,N,R IL E(or W& <br /> Property Owner's MailingFAddress Lot# Block# Subd.Name or CSM# <br /> 7-3 N1 ,, L 40 AV- 6 1 SWISS VI"49 E5rMS <br /> City Stat Zip Code Phone Number ❑ City ❑ Village ® Town Nearest Road <br /> 1uToW IWI 1.54'6151 ( 1154676-3154SWI53jMltjEkVA elRCt.E <br /> ❑ New Construction Use: ,�Residential/Number of bedrooms 2• Addition to existing building <br /> Replacement ❑Public or commercial-Describe: <br /> Code derived daily flow Sao gpd Recommended design loading rate bed,gpd/ft2 .'v trench,gpd/ft2 <br /> Absorption area required i9_bed,ft2 31-5� trench,ft2 <br /> �'7.0 Maximum design loading rate •7 bed,gpd/ft2 .—8trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s) ft(as referred to site plan benchmark) <br /> Additional design/site considerations <br /> Parent material 61AG/AL VIZIfr Flood plain elevation,if applicable A It <br /> S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank <br /> U = Unsuitable for system t4 S ❑ U 'N� S ❑ U Id S ❑ U IRS ❑ U I '® S ❑ U ❑ S W U <br /> SOIL DESCRIPTION REPORT <br /> Bonn # Horizon Depth Dominant Color Mottles Structure GPD/ft2 <br /> g in. Munsell Qu.Sz.Cont.Color FTexture Gr.Sz.Sh. Consistence Boundary Roots Bed , Trench <br /> I 7.SYR-S/f- ��� on�rs 1 Cs 'LVA •- •S6 61 7 S K 4 4 dM1 M1 J$ - M - . 6 <br /> Ground <br /> elev. <br /> �ft. ' <br /> Depth to <br /> limiting <br /> factor <br /> 'Lin. <br /> Remarks: <br /> Boring# <br /> 1 0.6 -7.54V 317- <br /> 1- <br /> z2 7.S14 9 4 1 <br /> Ground <br /> elev. <br /> �Qn _ <br /> Depth to �'d J7. <br /> limiting <br /> factor 96Ary 1}K46t2 f�i7/✓!✓{ <br /> >�in. Remarks: , <br /> CST Name (Please Print) Signature Telephone No. <br /> I AA1 J �IoPKfnls 715. 866- 4157 <br /> Address Date CST Number <br /> 27woo w 3S In��gs lz ti,Jl. .S48g3 a . 3 _ q7 3�1d <br />