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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 and 11iE'il.` �T <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. Parcel I.D.# <br /> —OZ-4160 <br /> APPLICANT INFORMATION - Please print all information. Reviewed by Date ppp <br /> Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). <br /> Props Owner !� Property Location <br /> �E/L7'4 e Re'6 4 /q/2 T Govt.Lot 2)3(� 1/4 1/4,S /�o T� ,N,R (� E(o�W <br /> Property Owner's Mailing Address Lot# Block# Subd.Name or CSM# <br /> 7t73E k4 c- ►Ha SNa(-> <br /> City State Zip Code Phone Number Ci Nearest Road <br /> 5534 (G E:1ty El Town <br /> l2-PAII— — 5' '044t 4 0--� I <br /> XNew Construction Use: %J�esidential/Number of bedrooms _ Addition to existing building <br /> ❑ Replacement ❑Public or commercial-Describe: <br /> Code derived daily flow 3A00 gpd Recommended design loading rate bed,gpd/ft2 `? trench,gpd/ft2 <br /> 4t <br /> Absorption area required 30 bed,ft2 3175 trench,ft2 Maximum design loading rate bed,gpd/112 S trench,gpd/ft2 <br /> r <br /> Recommended infiltration surface elevation(s) 4 I( ft(as referred to site plan benchmark) <br /> Additional design/site considerations <br /> Parent material `a C1(44G 74 �� �1Q L�`f Flood plain elevation,if applicable OA ' - ft <br /> S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank <br /> U = Unsuitable for system ❑ U V ❑ U O's ❑ U 1�f-S ❑ U S ❑ U ❑ S XU <br /> SOIL DESCRIPTION REPORT <br /> Boring # Horizon Depth Dominant Color Mottles Structure GPD/ft2 <br /> Texture Consistence Boundary Roots <br /> in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. Bed , Trench <br /> 1vz lz CS I mF2 li Ar <br /> �,=za '7,s4 f 2- '�/ ' LS Com, 1145614 VA F(j G a .77 <br /> Ground d`=dV ?i5'f l�' t--®i � SAt rn �— -h <br /> elevr <br /> Depth to <br /> limiting <br /> factor r, <br /> �in. <br /> Remarks: 04ctfe- NOE r'. T <br /> Boring # <br /> 0=6„ 7.SK t= 3/z L,S tai -OWPl2 65; 2 F $ <br /> a 6'25 W004 cs � <br /> =b3 7•S k q � SI toy _HYFKST <br /> Ground <br /> eley. S <br /> q6S_ ft. <br /> 17Z AV <br /> Depth to r <br /> limiting <br /> factor <br /> ,i,n. <br /> in. Remarks: � <br /> CST Na lease Print) Sign ' Telephone No. <br /> Address / r j' ,-` " Da CST Number <br /> 107" �J I W" ' S <br /> r <br />