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Wisconsin Department of Industry, SOIL AND SITE EVALUATION <br /> Labor.arld Human Relations Page_of_ <br /> pAvision.of Safety and Buildings in accordance with s. ILHR 83.09,Wis. Adm. Code <br /> Attach complete site plan on paper not less than B 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 /> pa0� 350 -L Toa <br /> APPLICANT INFORMATION - Please print all information. Reviewed by Date p <br /> Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). <br /> Proper Owner t f1 r/� Property Location <br /> J1 M oM I/V `1 Govt.Lot 1/4 1/4,S T N,R t E(or W <br /> Property Owner s Mailing dress Lot# Block# Subd.Name or CSM# 14J, f 2V1'e <br /> City State Zip Code N Phone Number ❑ City ❑ Village pp Town Nearest Road <br /> N Wt ( > <br /> ❑ New Construction Use: Residential/Number of bedrooms 2 Addition to existing building <br /> Replacement ❑Public or commercial-Describe:. <br /> Code derived daily flow 300 gpd Recommended design loading rate •7 bed,gpd/ft2 --0trench,gpd/ft2 <br /> Absorption area required qSq _bed,ft2 trench,trench,ft2 Maximum design loading rate bed,gpd/it2 •t trench,gpd/ft2 <br /> f)5-1Recommended infiltration surface elevation(s) -I 5-tr1 ft(as referred to site plan benchmark) <br /> Additional design/siteAAconsiderations <br /> Parent materiall� FlU n�l�T Flood plain elevation,if applicable _ ft <br /> S = Suitable for systemConventional Mound In-Ground Pressure f AT-Grade System in Fill Holding Tank <br /> U = Unsuitable for system [� s ❑ U XS ❑ U S ❑ U ®S ❑ U S ❑ U ❑ S U <br /> SOIL DESCRIPTION REPORT <br /> Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2 <br /> in. Munsell Cu.Sz.Cont.Color Gr.Sz.Sh. Bed Trench <br /> D-g rte' MS <br /> R3 <br /> M r <br /> •1 -g <br /> ,r <br /> Ground <br /> elev. <br /> 1,8 A ft. s 7 <br /> Depth to <br /> limiting <br /> f or <br /> in. <br /> Remarks: <br /> Boring# j .$ <br /> 2 ? 29 . 3 �J •'1 .8 <br /> 3 - �{r �� f 7 $ <br /> Ground <br /> lev. <br /> Depth to <br /> limiting <br /> f or <br /> 7 in. Remarks: &IV12 AUC O <br /> CST Name (Please Print) Signature Telep <br /> Nf�K►� KI s 7�s gib- S <br /> Address Date CST Number <br /> 27760 17 3670 <br />