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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 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. pa cel I.D.# <br /> a 1. Ol (00 IPL <br /> APPLICANT INFORMATION - Please print all information. Reviewed by ate <br /> Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). 7/�2 <br /> Property Owner p''-t Property Location <br /> ^r�gg2j Govt.Lot 1/4 1/4,S Z.7 T 4 ,N,R <br /> Property Owner's Mailing Address Lot If Block# Subd.Name or CSM# <br /> 51SS M IW64Z I fAff of LKS Rew (Imob mit 0l <br /> Ci State Zip Code Phone Number ❑ City ❑ Village Town Nearest Road <br /> HttE tK M1 1 SS110 (� 1 )6S2 o$oyjLAYERS <br /> ❑ New Construction Use: J�y(Residential/Number of bedrooms 3 Addition to existing building <br /> ❑ Replacement )5Public or commercial-Describe: <br /> Code derived daily flow 49? gpd Recommended design loading rate bed,gpd/fl2 trench,gpd/ft2 <br /> Absorption area required bed,ft2 trench,ft2 Maximum design loading rate bed,gpd/ft2 trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s)f4.7/QD ft(as referred to site plan benchmark) <br /> Additional design/site considerations .f <br /> Parent material 41, • IEC Flood plain elevation,if applicable NA 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 ❑ U <br /> SOIL DESCRIPTION REPORT <br /> Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2 <br /> in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. Bed Trench <br /> 10.7 IS49 2. � Ms <br /> Z z 6 rte' MS <br /> Ground <br /> lev. <br /> qR�aft. <br /> Depth to <br /> limiting <br /> ctor <br /> Z in. <br /> Remarks: <br /> Boring # <br /> Ground <br /> elev. <br /> ft <br /> Depth to <br /> limiting <br /> factor <br /> in. Remarks: <br /> CST Name (Please Print) Signal ur Telephone No. <br /> clbAi20 }f TWK/A/5 LW �s <br /> Address '.f qDa �fCST Number' <br /> 160 <br />