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Wisconsin Department of Industry, SOIL AND SITE EVALUATION <br /> Labor arA Auman Relations Page_L 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. Parcel I.D.# <br /> 070 2-2-Z 40 0,-).oa620 <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 /> ,q2,977- <br /> 7 7 L� Govt.Lot §- 1/4 1/4,S a T y&,N,R E(orQL <br /> Property Owner's Mailing Address Lot# Block# Subd.Name or CSM# <br /> /L/ 610c 9 #qv x7 plat a 34 P9LC- 5-2 <br /> Ci State Zip Code Phone Number Nearest Road <br /> ❑ City ❑ Village Town <br /> /U� -Zj� I t0i (7�s a5 / vla <br /> ❑ New Construction Use: ❑Residential/Number of bedrooms Addition to existing building <br /> replacement [--]Public or commercial-Describe: <br /> Code derived daily flow 30412 gpd Recommended design loading rate bed,gpd/fF 6 trench,gpd/ft2 <br /> Absorption area required - bed,It2 37 Strench,If 2 Maximum design loading rate_L7-bed,gpd/ft2 trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s) it ft(as referred to site plan benchmark) <br /> Additional design/site considerations <br /> ,��// NcN� <br /> Parent material 6d caal 6tL zgie= Flood plain elevation,if applicable k4— ft <br /> S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tan <br /> U = Unsuitable for system %,s EJ U ❑S ❑ S O�U ❑ S U ❑ S 0, ❑ S KU <br /> SOIL DESCRIPTION REPORT <br /> Borin # Horizon Depth Dominant Color Mottles Structure GPD/ft2 <br /> g Texture Consistence Boundary Roots <br /> in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. Bed , Trench <br /> M VFt <br /> Gro nn N j�• 71_T-q I2 T '--� A%5 I M 61Z �--� — - 7 : <br /> e]Qvr� <br /> Depth to <br /> limiting <br /> 7factt <br /> Remarks: AfA�- �^ <br /> Boring # <br /> 3 12 y W1��z A <br /> Ground <br /> eleyy <br /> fgt. <br /> Depth to <br /> 0 <br /> limiting q �f�g <br /> act K ���l'� l/c'L= />`j <br /> Remarks: !' <br /> CST Name lease Print) SignatuT lephone No. <br /> �N lel re 7/J- 2 <br /> Address DateY/ TCST Number <br /> 1 -7 4(3 �3s� ��9ivr5✓mac �i1i 9 g co <br />