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Wisconsin[)apartment of Industry, SOIL AND SITE EVALUATION <br /> Labor-and Human Relations Page of <br /> Division df Sifety 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 '8 C-1/'zo te, <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 <br /> Personal information you provide may be used for secondary purposes(Privacy Law,S.15.04(1)(m)). <br /> Property Owner Property Location /0c <br /> ';�7 4� ( Govt.Lot 3 1/4 1/4,S Y T_?k ,N.R j E(or <br /> Property Owner'sMailing Address I1 Lot If Block# S :-Name or CSM# <br /> l <br /> C'ty L Sta Zip Code Phone Number El city [I villa a (Town Nearest Ro <br /> ❑ New Construction Use: Residential/Number of bedrooms Addition to existing building <br /> ReplacementElPublic or commercial-Describe: <br /> Code derived daily flow30 ff,,er gpd Recommended design loading rate-- bed,gpd/ft2 =trench,gpd/ft2 <br /> Absorption area required bed,n2 trench,n2 Maximum design loading rate � bed,gpo:IM2 trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s) '— / (as referred to site plan benchmark) <br /> Additional design/site considerations �� <br /> Parent material G- 9 '.4 f d C if'f Flood plain elevation,if applicable ZJ/4- it <br /> S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank <br /> U = Unsuitable for system ❑ S �U El ,® <br /> S .0 ❑ S ®-U ❑ S 0_U El U �S ❑ U <br /> SOIL DESCRIPTION REPORT <br /> Boring# Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2 <br /> in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. Bed Trench <br /> 7 5- <br /> Ground <br /> elev. <br /> n. <br /> Depth to <br /> limiting <br /> factor <br /> �in. <br /> Remarks: <br /> Boring # <br /> Ground <br /> elev. <br /> n <br /> Depth to <br /> limiting <br /> factor <br /> in. Remarks: <br /> CST Name (Please Print) Signature Telephone No: <br /> Address t. Date Cumber <br /> ST N <br />