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Wistconsin Department of Industry, SOIL AND SITE EVALUATION Page of <br /> Labor and Human Relations <br /> Division of Safety and Buildings in accordance with s. ILHR 83.09, Wis. <br /> Attach complete site plan on paper not less than 81/2 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 /> 0�0- <br /> APPLICANT INFORMATION - Please print all information. Reviewed by/(ice Date <br /> Personal Inform <br /> Information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). Z/ <br /> Property Owner7 Properly Location / <br /> M e J O S Govt.Lot S Cj 1/4 /WW1/4,S 2A T VO ,N,R /6 E(or) N� <br /> Property Owner's Mailing Add ss Lot# Block# Subd.Name or CSM <br /> X 833 Co. w7 C — — <br /> city State Zip Code Phone Number /r' Nearest Road <br /> ,D„�cbwr wF syr 3d 1 ( ) '9,W-711f Elcity Elvillage 0 Town CU• R� <br /> ❑ New Construction Use: BResldemal/Number of bedrooms Z- Addition to existing building <br /> .Replacement ❑Public or commercial-Describe: — <br /> Code derived daily Flow Q U gpd Recommended design loading rate ? be J,gpd/ft2_, do trench,gpd/f12 <br /> Absorption area required bed,ft2_s3�trench,it Maximum design loading rate i 7 be J,gpd/fe-1-00—trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s) /O it(as referred to site p an benchmark) <br /> Additional design/site considerations — <br /> Parent material (3 //¢C. /R-/ Flood plain elevation,if applicable Iv/T ft <br /> S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank <br /> U = Unsuitable for system s ❑ u s ❑ u ® s ❑ u s ❑ u ®s ❑ u ❑ s ft u <br /> SOIL DESCRIPTION REPORT <br /> Boring# Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/fl2 <br /> E in. Munsell Ou.Sz.Cont.Color Gr.Sz.Sh. Bed Trench <br /> / C-S 7,s R3/z — s 36 Mfr cs 3f b' <br /> Ground <br /> elev. <br /> " <br /> Depth to <br /> limiting <br /> factor <br /> ZZin. <br /> Remarks: <br /> Boring # �• <br /> on2 -2 7 1,1_Y1( % /.S /,1�rr <br /> Q3 -73 7,TYlf <br /> Ground <br /> elev. <br /> Depth to <br /> limiting <br /> tactor <br /> 773 in. Remarks: <br /> CST Name (Please Print) Signature Telephone No. <br /> Address Date CST Number <br />