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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 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. parcel I.D.# <br /> C, C«� <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)). r�/7# <br /> Property Owner Property Location <br /> Govt.Lot 6 1/4 1/4,S 35 T q 1 ,N,R E(or)(0 <br /> Property Owner's Mailing Address Lot# Block# Subd.Name or CSM# <br /> _116,59 5Q1ZMAIJ1419 LE CQES <br /> City Rte• State Zip Code Phone Number Nearest Road <br /> JER K l- MI $5076 I (G 17- )q55- (o q9q ❑ city visage ® Town nIER✓ /�fJG l <br /> New Construction Use: CgResidenbal/Number of bedrooms -3 Addition to exiStirig building <br /> Replacement Public or commercial-Describe: <br /> Code derived daily flow gpd Recommended design loading rate •1 bed,gpd/fF . OOtrench,gpd/ft2 <br /> Absorption area required gibed,ft2 JrG3 tre h,ft2 Maximum design loading rate bed,gpd/ft2- $ trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s) • (o �{LT (��• I ft(as referred to site plan benchmark) <br /> Additional design/site considerations <br /> Parent material LPt(-1 FK DRI F T Flood plain elevation,if applicable NA ft <br /> S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System"In-A-17-1—Holding Tank <br /> U = Unsuitable for system MS ❑ U 0S ❑ U ®S ❑ U ® S ❑ U RS ❑ U ❑ s XU <br /> SOIL DESCRIPTION REPORT <br /> Boring# Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/f12 <br /> in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. Bed Trench <br /> 1 ! 0 <br /> -1.54R 1 .8 <br /> Z bjVo 'LS R 4 (D <br /> Ground <br /> 'Qelev�ft. <br /> Depth to <br /> limiting . <br /> fpc)or <br /> 7( loin. <br /> Remarks: RaAlp AU6512 BoRmijj <br /> Boring# <br /> I 0.5 Ms 6 M3e, •-7 S <br /> z -65 �.S 5! 6 MS d M •� .8 <br /> Ground <br /> Depth to <br /> limiting n6 4-3 <br /> >��factoropja -( <br /> in. Remarks: <br /> CST Name (Please Print) Signature Telephone No. <br /> Address Date CST Number <br /> 2 60 w 3S a68SM)P, 01. SC1893 lI- 5- 6 3670 <br />