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Wisconsin Department of Industry, SOIL AND SITE EVALUATIOwh ` <br /> Labor and Human Relations Page 1 of <br /> Division of safety and Buildings in accordance with s. ILHR 83.09, Wis. A""w <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 uRtJjerr <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. Parcel I.D.# <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 /> 13op-, Govt.Lot 4 1/4 1/4,S 25T J�o ,N,R 14 E(ce <br /> Property Owner's Mailing Address Lot# Block# Subd.Name or CSM# <br /> 2:1&4-0 AD _ 3 V. 2 P- l l3 <br /> City Stat Zip Code Phone Number ❑ Ci El Village Town Nearest Road <br /> �oOrJaz �l $OI ( IS )( -$51 1 LL <br /> New Construction Use: residential/Number of bedrooms Z Addition to existing building <br /> Replacement Public or commercial-Describe: <br /> Code derived daily flow 3oa gpd Ar 1.Z Recommended design loading rate • 7 bed,gpd/ft2 $ trench,gpd/112 <br /> Absorption area required bed,ft27—SD rench,It 2 Maximum design loading rate -1 bed,gpd/ft2 A trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s) 17 03 ,/ ft(as referred to site plan benchmark) <br /> Additional design/sittg considerationns�Cnizi- Ueiwwr — f�6 " ,�A � 0AI— in <br /> Parent material 1 '�cxlix Daly r Flood plain elevation,if applicable ft <br /> S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank <br /> U = Unsuitable for system ❑S M U I� S ❑ U ❑ S � U ❑S Nu ❑ S ® U 9 S ' U <br /> SOIL DESCRIPTION REPORT <br /> Boris # Horizon Depth Dominant Color Mottles Structure GPD/ft2 <br /> 9 Texture Consistence Boundary Roots <br /> in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. Bed , Trench <br /> I 3 Asx Zvj . 7 <br /> 2 3 18 7 - A4 6 Ac Acet M7 s _ .77 S <br /> Ground 3 $' 75YA 414 62-d SVC S S /t 17 CS 7 <br /> �lev. <br /> ft. 7 iI4e ;/_Z S Q s ! -� . 7 .8' <br /> Depth to <br /> limiting <br /> factor <br /> —ULin. <br /> Remarks: %'7lxt1V0 517 /115 a62Z Acct 20165, A 0_ <br /> Boring # <br /> 2 2 3 /4 ` '�� f A41 05 7 .8 <br /> 3 19.2 6 Gro/ itis as C,s <br /> Ground /L f ZZ s M l (j 7 •g <br /> qZW [L77-A AZ4 / 3 M/ ✓ .7 S <br /> Depth to <br /> limiting <br /> r <br /> tylp <br /> .11t_in. Remarks: <br /> CST Name (Please Print)1 Signature Telephone No. <br /> c>}ARO 10OK1>`l5 �5-$- <br /> Address Date CST Neu bier <br />