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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 domplete 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 andMkT <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. parcel I.D.# <br /> 0/ 110 or /S <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 /> ED XE Govt.Lot 11/4- 1/4,S 2/ T 3'?•,N,R /7 E(orj5P <br /> Property Owner's Mailing Address Lot# Block#- Subd.Name or CSM# <br /> ssdoz( o. Sf- y.4 SLYI NWry <br /> Ci ty State Zip Code Phone Number ❑ City ❑ village Town Nearest Road <br /> SQST59 V 1543131 ( IfLU-50011M IM 9D _ <br /> ❑ New Construction Use: 55Residential/Number of bedrooms 3 Addition to existing building <br /> XReplacement E Public or commercial-Describe: <br /> Code derived daily flow 42 gpd Recommended design loading rate •7 bed,gpd/ft2 -$ trench,gpd/ft2 <br /> Absorption area required _bed,ft2 S43 trench,ft2 Maximum design loading rate bed,gpd/ft2 -8 trench,gpd/ft2 <br /> Recommended infiltration surface elevationQp // <br /> s) "(_I - b3 ft(as referred to site plan benchmark) <br /> Additional design/site considerations <br /> Parent material ( (l Acl11}, AZIFT Flood plain elevation,if applicable NA ft <br /> S = Suitable for system Conventional WS <br /> In-Ground Pressure AT-Grade System in Fill Holding Tank <br /> U = Unsuitable for system ❑ S X U lai S ❑ U ❑ S KU ❑ S i® U ❑ S U ❑ S 5�7 U <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 /> 3A �--- s . 7 8 <br /> Grounda", <br /> 3 ... Me: NP <br /> Depth to <br /> ?,. R• <br /> limiting �. <br /> factor <br /> ELI, <br /> Remarks: �1�Aw A 4& BoQttv4 <br /> Boring # <br /> i 0- R 3 <br /> -33 S 8 NP P <br /> Ground <br /> 07 elev. <br /> O ft. <br /> Depth to <br /> limiting <br /> "Lin. Remarks: �qN+� t►UlEtL �OI�i'IVS <br /> CST Name (Please Print) Signature Telephone No. <br /> c o zJAI �{ <br /> Addre Date CST Number <br /> 7 6 0 w 3S ( 651M W/. S� 8 - 670 <br />