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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 andEXCOWEgr <br /> percent slope,scale or dimensions,north arrow,and locroad. _ parcel I.D.# <br /> 1 032- SSofs•10 <br /> APPLICANT INFORMATION- Please print all information. Reviewed b Qi,S "�6f Date <br /> Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). S a <br /> Property Owner /� Property Location <br /> Soo Ft LS Govt.Lot $ 1/4 1/4,S $ T 41 ,N,R 1-5 E(or)0 <br /> Property Owner's Mailing Address Lot# Block# Subd.Name or CSM# <br /> ((4o C(r 14-r'of4 A%/- S - 1 V. 13 P- 25 <br /> City State Zip Code Phone Number ( <br /> ❑ City F-1 Village Town Nearest Road <br /> 1010 6L49 I MI.1 Iss Pt Es c.k: RDyj _ <br /> c� <br /> 12 <br /> ❑ R9 <br /> - <br /> New Construction Use: Residential/Number of bedrooms Z Addition to existing building <br /> Replacement ❑Public or commercial-Describe: <br /> Code derived daily flow 3� gpd Recommended design loading rate .-I bed,gpd/ft2 '& trench,gpd/ft2 <br /> Absorption area required ftl _bed,ft2 322 trench,ft2 Maximum design loading rate bed,gpd/ftz • $ trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s) 91. 160 ft(as referred to site plan benchmark) <br /> Additional design/site� considerations .I <br /> Parent material LACiAg 1 gjJ1 T' Flood plain elevation,if applicable A/A ft <br /> S = Suitable for system Conventional Mound In-Ground Pressure AT-GradeSystem in Fill Holding Tank <br /> U Unsuitable for system ® S ❑ U ®S ❑ U ® S El ® S ❑ U ® S ❑ U ❑S MU <br /> SOIL DESCRIPTION REPORT <br /> Boris # Horizon Depth Dominant Color Mottles Structure GPD/ft2 <br /> Boring Texture Consistence Boundary Roots <br /> in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. Bed , Trench <br /> f 1 t7 S 194 st 2LO 1 -Y <br /> �- 5- R .416 Ns M1 S <br /> Ground <br /> ft. <br /> Depth to <br /> limiting <br /> fa for <br /> 7��in. <br /> Remarks: <br /> Boring # <br /> t 0•S 7• R 3 2 r—� �s � .S <br /> 2 5-S' 7 t 41G Ms <br /> Ground <br /> elev. <br /> ft. <br /> Depth to <br /> limiting PA <br /> fac c r <br /> )n. Remarks: <br /> CST Name (Please Print) Signature Telephone No. <br /> 1 cMAs2P 14wgilJ3 &�A -n S <br /> Address O W C17�►Gc W 1 - r Date CST Number <br /> 7" I Z.7 4�D I <br />