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Wisconsin Department i Industry, SOIL AND SITE EVALUATION ! <br /> Labor and SafetyHumaRelations O R I G I N Aage_of_ <br /> Division of Safety and Buildings in accordance with s. ILHR 83.09, Wis. Adm. Coe L <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 U <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. parcel I .# <br /> bla-9101-01-&� <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)). r>_ �6—L <br /> Property Owner Property Location J <br /> STA1J AM 11>0rl Govt.Lot 1/4 1/4,S 'j T 40 ,N,R 1.5 E(ole <br /> Property Owner's Mailing Address Lot#� Block# Subd.Name or CSM# <br /> 2A057 BjZ0Cq4W400 TERuz_ g <br /> City State Zip Code Phone Number 1:1t <br /> Ci Village Town Nearest Road <br /> MPLS M14 559-Io ( O0 )329-�g. ; ❑ .N i <br /> csS�1 <br /> WA go <br /> XNew Construction Use: 14 Residential/Number of bedrooms 3 Addition to existing building <br /> ❑ Replacement ❑Public or commercial-Describe: <br /> Code derived daily flow gpd Recommended design loading rate •7 bed,gpd/ft2-$ trench,gpd/ft2 <br /> Absorption area required bed,ft2 sir3 trench,ft2 Maximum design loading rate . 7 bed,gpd/ft2 •$ trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s) 4'9'•s ft(as referred to site plan benchmark) <br /> Additional design/site considerations G <br /> Parent material AYAL A21 r r Flood plain elevation,if applicable A/A n <br /> S = Suitable for system Conventional Mound In-Ground Pressure I AT-Grade System in Fill Holding Tank <br /> U Unsuitable for system S ❑ U )? S ❑ U % S ❑ U AS E1U �d S ❑ U ❑ S CKU <br /> SOIL DESCRIPTION REPORT <br /> Boring# Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/n2 <br /> ry <br /> in. Munsell Qu.Sz.Cont.Color Gr. Sz.Sh. Bed , Trench <br /> .* 7 Q to 7 $ <br /> 2 q(, 75719414 <br /> ice <br /> Ground3 %. 7S ,C 4¢ �� /�tS <br /> glev. <br /> 7.0 ft. <br /> Depth to <br /> limiting <br /> fat r <br /> 774n. L <br /> Remarks: <br /> Boring # 1 <br /> ( . �I CS Zco 1 8 <br /> 2 2. 481 7-S41L 4 qj( 2" $ <br /> 3 -TS 1.!;qK 44 10^ 1 _8 <br /> Ground <br /> elev. <br /> q3. <br /> Depth to 2� <br /> limiting <br /> factor <br /> Z7�in. Remarks: <br /> CST Name (Please Print) Signature Telephone No. <br /> 7 4-1,s-7 <br /> Addres& Date CST Number <br /> 7-.1-7/,0 5 _ (0_ 00 S S <br />