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Wisconsin Department of Industry, SOIL AND SITE EVALUATION <br /> I,abor andrHuman 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 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 /> 1711, 3 /a C / o e <br /> APPLICANT INFORMATION- Please print all information. Reviewed by / Date <br /> Personal information you provide may be used for secondary purposes(Privacy Law,s.15.64(1)(m)). <br /> Property Owner 1 Property Location '00 c/ <br /> C AJ 1 d^J Govt.Lot S'J 1/4k/t1/4,S 2 T3 y ,N,R/ 7 E(or OW <br /> Property Owners Mailing Address Lot# Block# Subd.Name or CSM# <br /> City / ` tate Zip Code Phone Number ❑ City ❑ Village 2!� Town Nearest Road <br /> eb STt/ G✓S syp9� c )SGr,�Yl9 G /:eco%J e A-) <br /> New Construction Use: residential/Number of bedrooms Addition to existing building <br /> El Replacement Public or commercial-Describe: / <br /> Code derived daily flow 95-0 god Recommended design loading rate S bed,gpd/112��trench,gpd/f12 <br /> Absorption area required 9�D bed,ft2 �7$ trench,ft2 Maximum design loading rate ;bed,gpd/f(2 _etrench,gpd/ft2 <br /> Recommended infiltration surface elevation(s) si �' ft(as referred to site plan benchmark) <br /> Additional design/site considerations <br /> Parent material //¢c-/A �/'��� Flood plain elevation,if applicable.. ft <br /> S Suitable for system Conventional Mound In-Ground Pressure IAT-Grade System in Fill Holding Tank <br /> U = Unsuitable for system S ❑ U �K S ❑ U Ss U '5�TS ❑ U zjS ❑ U ❑ S PqU <br /> SOIL DESCRIPTION REPORT <br /> Boring# Horizon Depth Dominant Color MottlesStructure GPD/ft2 <br /> in. Munsell Qu.Sz.Cont.Color Texture Gr.Sz.Sh. Consistence Boundary Roots <br /> Bed , Trench <br /> y , pR �/ �/5 k r w ,s <br /> Ground <br /> elev. 6r�- �Jr <br /> Depth to <br /> limiting <br /> factor <br /> in. <br /> Remarks: <br /> Boring# <br /> 7, q6 <br /> Ground <br /> elev. <br /> Depth to <br /> limiting <br /> Wfc <br /> in. Remarks: <br /> CST Name (Please Print) Signature Telephone No. <br /> Address Date CST Number <br /> /.36 x 37/ & SL7 2 ,;,?.2 <br />