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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. <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 /> APPLICANT INFORMATION- Please print all information. Reviewed by Date / I/ <br /> Personal information you provide my be used for secondary purposes(Privacy Law,s.15.D4(7)(m)). /�!�'�T <br /> Props OwnerT / Property Location <br /> Vp�lN.5eo.J Govt.Lot Nc.11/4Nw1/4,Scj(� T / ,N,R /6 E(or)N <br /> Property Owner's Mailing Address Lot# Block# Subd.Name or CSM# <br /> P o B /2a <br /> City State Zip Code Phone Number Nearest oad <br /> Yt4r ❑ city- ;'Q ® TownIn, UA DAM RJ <br /> �ew Construction Use: CgResidentiai/Number of bedrooms '2 Addition to existing building <br /> eplaosment ❑Public or commercial-Describe: <br /> Code derived daily flow 200 gpd Recommended design loading rate 1 7 bed,gpdtfi rench,gpd/ft2 <br /> Absorption area required ya 9' bed,nZ 37S trench,ttz Maximum design loading rate <br /> o�+ g g --,7—bed,gp trench,gpdttt2 <br /> Recommended Infiltration surface elevation <br /> n((s) 9.hi S- ft(as referred to site plan bent mark) <br /> Additional design/site considerations // Z fisc /n■'.0 f 'W."'U <br /> , <br /> Parent material G IAC ii4/ r i" Flood plain elevation,if applicable e4 tt <br /> S - Suitable for system Conventional Mound In-Ground Pressure I AT-Grade Systenn in Fill Holding Tank <br /> U = unsuitable for system V s ❑ U S ❑ U ®S ❑ U ,0 s ❑ u 0s ❑ u ❑ s lW <br /> SOIL DESCRIPTION REPORT <br /> Boring# Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundi ry Roots GPD/ft2 <br /> In. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. Bed ,Trench <br /> 0-3 7-525�13 o? {c 0 8 <br /> Ground .3 <br /> elev. - <br /> �k. <br /> Depth to <br /> limiting <br /> ctor <br /> in. <br /> Remarks: �a � o /h o7L <br /> Boring# / <br /> Ela 3Y 7.571F 2 ; 7 <br /> 3 7s7,e %6 — so :J <br /> Ground <br /> elev. <br /> Depth to <br /> limiting <br /> factor <br /> 77.2 in. Remarks: <br /> CST Name (Please Print C / / Signature / / Telephone No. ry/ <br /> ca/G w /jff n/i+t Lvy—.+mac.. <br /> Address Date C T Number <br />