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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 <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. <br /> Parcel l.D.'# <br /> APPLICANT INFORMATION- Please print all information. 1Z 42Z$ 03 l� <br /> Reviewed by Date J <br /> Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). p/� <br /> Property Owner Property Location ZS <br /> TAIlLe Govt.Lot NW1/4 NW 1/#,S. 2ST 40 -,N,R 15 E(or&W <br /> Property Owner's Mailing Address Lot# Block# Subd.Name or CSM# <br /> 204027 V. T 10 1 1 <br /> Ci State Zip Code Phone Number <br /> W I 1514S193 I <br /> ❑ City ❑ Village ® Town Nearest Road <br /> KS0rj p. FLO. A <br /> New Construction Use: 50 Residential/Number of bedrooms 3 Addition to existing building <br /> ❑ Replacement ❑Public or commercial-Describe: <br /> Code derived daily flow 4,50 - gpd Recommended design loading rate •-7bed,gpd/f? -Q trench,gpd/112 <br /> Absorption area required (043 bed,ft2 n03 tre/�pc�h,ftz Maximum design loading rate -7 bed,gpd/fl2 -g trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s) R�1.2 /HCT q y,Sft(as referred to site plan benchmark) <br /> a <br /> Additional design/site considerations 5V2 'II4 �S 13A1,105 ?R(S&ll 1N All 'B01Z)045 <br /> Parent material _ta LACI RL R 1�Pr Flood plain elevation,if applicable Np ft <br /> S = Suitable for system Conventional 1MMound In-Ground Pressure AT-Grade System in Fill Holding rrT��alInk <br /> U Unsuitable for system �] S ❑ U use S ❑ U RS ❑ U NIS ❑ U M S ❑ U ❑S I] U <br /> SOIL DESCRIPTION REPORT <br /> Boring# Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ftz <br /> in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. ry Bed Trench <br /> s ,7 .g <br /> 2 6- -7.5)Lw y <br /> Ground 5' S <br /> Depth to <br /> limiting <br /> factor <br /> in. <br /> Remarks: _A1/A/D ,A[Ii� 1,7 <br /> Boring # rr <br /> ( .6 TS4_9_3 S DHS S T 8 <br /> 2 2 6-30 <br /> �- MS oris MI ` es .8 <br /> 3 s M S CM36 IL4 <br /> Ground <br /> 9�ley. <br /> tt_ v' <br /> Depth to <br /> limiting <br /> factor <br /> *> in. Remarks: <br /> CST Name (Please Print) Signature Telephone No. <br /> lc R oPKin/s u�.l�dS• gG6- 5 <br /> Address <br /> Date CST Number7 7o Dg <br /> 3670 <br />