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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 complete site plan on paper not less than 6 1/2 x 11 inches in size. Plan must County / <br /> include,but not limited to: vertical and horizontal reference point(BM),direction and �URn/Elrt <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. Parcel I.D.If <br /> 03Z 532.1 01 loo <br /> APPLICANT INFORMATION - Please print all information. Reviewed by I 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 /> 'I L CLE/JOEn)ln( Govt.Lot3 1/4 1/4,S7,1 T L41 ;N R 116 E( <br /> Property Owner's Mailing Address Lot# Block# Subd.Name or CSM# E. j aS OF S. 2S <br /> 7478 bA K Sr. Ey V. 91 • "1 V.It IF q15 <br /> City State Zip Code Phone Number ❑ Crty ❑ Village Town Nearest Road <br /> DA4BLIF WI SNS3o (11S )4-A54-,-Na OAK ST <br /> New Construction Use: Residential/Number of bedrooms _ Addition to existing building <br /> Replacement ],� Public or commercial-Describe: <br /> Code derived daily flow gpd Recommended design loading rate .� bed,gpd/ft2 .00 trench,gpd/ft2 <br /> Absorption area required _bed,ft2 _trench,ft Maximum design loading rate -.7 bed,gpd/ft2 -, trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s) 95. 9 ft(as referred to site plan benchmark) <br /> Additional design/site considerations <br /> Parent material GL.ACI q L 'DRIC-T Flood plain elevation,if applicable N ft <br /> S = Suitable for system I <br /> Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank <br /> U Unsuitable for system I N S ❑ U X S ❑ U ®s ❑ u I Ms ❑ u US ❑ U ❑ S 1K 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 /> i 0-7 1.51/g 31/7_ s OKs dl <br /> i 7.Zy 7 is N b sw ods d1 Cs 7 .8 <br /> Ground 3 T'S R y �� MS O Ml CS �� 7 <br /> ,Dleiv �-- <br /> -7/ svx oM5 Ml S .4 <br /> Depth to <br /> limiting <br /> factor <br /> 54 in. , <br /> Remarks: K�NEO WA1159 71 <br /> Boring <br /> 0- <br /> 3 Ns .7 <br /> Ground -&% C2d S S •L <br /> v. <br /> + <br /> 1.5 ft. <br /> Depth to <br /> limiting <br /> !f ctor �1_ <br /> rn. Remarks: ttAND A�rcR�o+G� <br /> CST Name (Please Print) Signature Telephone No. <br /> /cNq 00<1AIS - '1/S- $(o(,- S <br /> Address Date CST Number <br /> 27760 dwy 3S 0EB51-ER wi • _51913 (P- 1 -4 7 3470 <br />