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Wisconsin Department of Industry, SOIL AND SITE EVALUATION <br /> Labor and H,iman 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 �J G <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. parcel I.D.# a <br /> a 533s a a <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)). Y-o� <br /> Property Owner I Property Location <br /> ,TT) Y © .--n A- /— Govt.Lot 1/4 1/4,S3_57'T y N,R/Z E(ore <br /> Property er's Mailing Address Z Lot# Block# Sum Name or CSM# <br /> I>l'�l 7 / �a /-3/7 <br /> City State Zip Code Phone Number <br /> ❑ City ❑ Village ;�5-Town Nearest Road <br /> 1715�0cr11 <br /> New Construction Use: Residential/Number of bedrooms � Addition to existing building '-- <br /> Replacement b Public or commercial-Describe: <br /> Code derived daily flow 7aO gpd Recommended design loading rate 7 bed,gpd/flZ1S7' trench,gpd/ft2 <br /> Absorption area required_ bed,ft2 LY trench,ft2 Maximum design loading rate e7 bed,gpd/ft2 ' ? trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s) y� 9 ft(as referred to site plan benchmark) <br /> Additional design/site considerations -/ <br /> Parent material Cs�.4 C<L9- G� /`j / Flood plain elevation,if applicable r✓A{— ft <br /> S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank <br /> U unsuitable for system E] u ❑ U KS El fis ❑ U V54 ❑ U ❑S �u <br /> SOIL DESCRIPTION REPORT <br /> Boring # Horizon Depth Dominant Color Mottles Structure 5, Trench <br /> Texture Consistence Boundary Roots <br /> in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. <br /> zgld <br /> /S 72 ' L7 <br /> Ground <br /> lev. l r f <br /> ft. <br /> Depth to <br /> limiting <br /> factor <br /> Remarks: <br /> Boring # / L <br /> y� �P s r -tea <br /> Ground <br /> Depth to <br /> limiting 1 117 <br /> factor <br /> in. Remarks: <br /> CST Name (Please Print) //Signature Telephone No. <br /> Zd // �y <br /> Address Date CST Number <br />