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Wisconsin Department of Industry, SOIL AND SITE EVALUATIONO D ' ('�v � <br /> Labor and Fluman Relations [� <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 Iocabon and distance to nearest road. parcel I.D.# <br /> Oa- °� 101-d1- <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 <br /> Govt.Lot 1/4 1/4,S 7 T 40 ,N,R E(oO& <br /> Property Owirfeet Mailing Address Lot# Block# Subd.Name CSM# <br /> :Z267900 -4- N _ �I n I„ s 0 t,db <br /> CityStaa Zip Code P(one Number 1-1 city El Village � Town Nearest Road <br /> M145$D?_S i 1H 6514A-2"11. SFIcK R , <br /> New Construction Use: Residential/Number of bedrooms 3 Addition to existing building <br /> Replacement Public or commercial-Describe: <br /> Code derived daily flow 45Or gpd Recommended design loading rate bed,gpd/ftZ • $ trench,gpd/ft2 <br /> Absorption area required (043 bed,ft2 5[.3 tr ch,ft2 Maximum design loading rate bed,gpd/ft2 •8 trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s) 93.7 3.0 t(as referred to site plan benchmark) <br /> Additional design/site considerations <br /> Parent material GLyI14 M Fir Flood plain elevation,if applicable tt <br /> S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank <br /> U = Unsuitable for system S U WS ❑ U W S El ®S ❑ U ISY S ❑ U ❑ S RU <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 /> Z 4 A0 2 co :7 ' -8 <br /> Ground <br /> eleey. <br /> 15 ift. <br /> Depth to <br /> limiting <br /> fac <br /> Remarks: <br /> Boring # <br /> o-S 0.3 0A al 4 21-7 $ <br /> Z <br /> 1 $- 7• R-4 4 Ms DS dl 2.co •1 g <br /> Grro,-u�nd <br /> yg <br /> ft. � <br /> Depth to <br /> limiting <br /> f�pt�r <br /> - bio in. Remarks: <br /> CST Name (Please Print) Signature Telephone No. <br /> - <br /> CH RD ,Js �1S- KPID 415 <br /> Address Date CST Number <br /> 2-'17&0 Awy 29 L✓Q3StM 11 . 54893 3-10-60 =:951 <br />