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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. Parcel I.D.# <br /> 4b3a - sa/7 . o /you0 <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 —v <br /> Govt.Lot a 1/4 1/4,S / 7 T Z// ,N,R /s E(or)e <br /> Property Owner's Mailing Address Lot# Block# Subd.Name or CSM# <br /> (U _3 , )��sanl QE) <br /> City State Zip Code Phone Number El City [_1 Village )� Town Nearest Road <br /> D'QX&oc WI 1 5`183Z) I ( '?/> )6s/-- 3)81/ 1 Sa�/35 r/4,0,95 1,094-- ep <br /> ❑ New Construction Use: ❑Residential/Number of bedrooms C— Addition to existing building <br /> Replacement ❑Public or commercial-Describe: <br /> Code derived daily flow >60 gpd Recommended design loading rate , 7bed,gpd/ft2 `9 trench,gpd/112 <br /> Absorption area required UQ bed,ft2 375 trench,ft2 Maximum design loading rate 17 bed,gpd/fl2 • O-/ trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s) �� '� �/ ft(as referred to site plan benchmark) <br /> Additional design/site considerations <br /> Parent material 6(_,�or4-,L Ml;�f-r Flood plain elevation,if applicable ft <br /> S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank <br /> U = Unsuitable for system t4-S ❑ U 1K S ❑ U U�S ❑ U -Ws ❑ U S •Q"U ❑ S `U <br /> SOIL DESCRIPTION REPORT <br /> Boring # Horizon Depth Dominant Color Mottles Structure GPD/ft2 <br /> in. Munsell Qu.Sz.Cont.Color Texture Gr.Sz.Sh. Consistence Boundary Roots <br /> Bed Trench <br /> 6-%!L 7 Sy 2 o v LS — FS <br /> Ground <br /> alev . <br /> AF <br /> Depth to <br /> limiting <br /> factor <br /> in. <br /> Remarks: <br /> Boring # <br /> 0— 3 MDN S 5'G o2 J' <br /> 7, fie) -- s s6, © G <br /> Ground <br /> ft. <br /> Depth to <br /> limiting <br /> fact r <br /> in. Remarks: 4oc-. {�-1 <br /> CST Name (Please Print) Signa Telephone No. <br /> Address Date CST Number <br />