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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 /> 02sI13 02 top <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 /> EOR SO D L Govt.Lot Z 1/4 1/4,S I$ T J$6 ;N,R 1-t E(or OW <br /> Property Owner's Mailing Address Lot# Block# Subd.Name or CSM# <br /> SZ7 Dac- E/Z WOOD DR . 4 OL. 4 Y $•9 <br /> City State Zip Code Phone Number <br /> -S. ST. PAUL MA/- 55075 ( 612 )q5l-2,70$ ❑ City Village Town Nearest Road <br /> RD <br /> ❑ New Construction Use: ,KResidential/Number of bedrooms 3 Addition to existing building <br /> XReplacement ❑Public or commercial-Describe: <br /> II'' <br /> Code derived daily flow '1S0 gpd Recommended design loading rate .5 bed,gpd/f12 6 trench,gpd/ft2 <br /> Absorption area required 9 oa bed,ft2 /finp trench,ft2 Maximum design loading rate .5 bed,gpd/ft2 .-r- trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s) "1"1. 1 ft(as referred to site plan benchmark) <br /> Additional design/site considerations <br /> Parent material 6LACI AL DRIFT' Flood plain elevation,if applicable /uK{ ft <br /> S = Suitable for system I Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank <br /> U = Unsuitable for systeml ® S ❑ U ® S ❑ U j9S ❑U I 2rS ❑ U ® S ❑ U ❑ S (? U <br /> SOIL DESCRIPTION REPORT <br /> Boring # Horizon Depth Dominant Color Mottles Structure GPD/ft2 <br /> in. Munsell Qu.Sz.Cont.Color FTexture Gr.Sz.Sh. Consistence Boundary Roots <br /> Bed , Trench <br /> I 1 0 b S 2 dl C 5 :?--16.63 7-s dl hl M s G <br /> Ground 69 s <br /> elev. 5 R S S <br /> iMAI ft. <br /> Depth to <br /> limiting M f ctorf ctor <br /> in. <br /> Remarks: <br /> Boring # <br /> 04, -7 3z J– — S 5 .` <br /> n2 `` 6607. r 9 <br /> Ground <br /> el''ev`` <br /> I eft. <br /> ' Depth to <br /> limiting L �. <br /> fa for <br /> >0 in. Remarks: gHtJo AL14199 R0)2jr44 <br /> CST Name (Please Print) Signature Telephone No. <br /> Address Date CST Number <br /> ZZ-7-760 & 3S �W695TZr2 LFII. —5'893 -2,3 -17 3670 <br />