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Wisconsin Department of Industry, SOIL AND SITE EVALUATION 0 R I G t N A <br /> Labor and Human Relations a 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 &"em <br /> em <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. parcel I.D.# <br /> 018 .3V7_ 01 SM <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 /> HAW <br /> SG4M I D Govt.Lot 1/4 1/4,S Z T N,R `6 E(o W <br /> Property Owner's Mailing Address Lot# Block# I Subd.Name or CSM# <br /> o- 45 W.5 <br /> City State Zip Code Phone Number ❑ City ❑ Village Town Nearest Road <br /> ( f-k. <br /> >1New Construction Use: L2SI Residential/Number of bedrooms 3 Addition to existing building <br /> El Replacement b Public or commercial-Describe: <br /> Code derived daily flow gpd Recommended design loading rate •1 bed,gpd/ft2 - $ trench,gpd/tt2 <br /> Absorption area required G43 bed,ft2_5 2—trench,ft Maximum design loading rate -7 bed,gpd/fie -9> trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s) 9D-0 it(as referred to site plan benchmark) <br /> A -746 <br /> 6 i <br /> Additional design/site considerations_ALX_ 5M 10111 O W -7 f0- Ct$ _ A&A im;0 Aft.g 5 0 <br /> Parent material "AL D91 1" Flood plain elevation,if applicable hfl? ft <br /> S = Suitable for system Conventional Mound In-Ground Pressure AT-GradeSystem in Fill Holding Tank <br /> U = Unsuitable for system Xs ElU ®S ❑ U 9S ❑ U MIS ElU Ms ❑ U ❑ S �6 U <br /> SOIL DESCRIPTION REPORT <br /> Boring# Horizon Depth Dominant Color MottlesTexture Structure Consistence Boundary Roots GPD/ft2 <br /> in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. Bed Trench <br /> 17 <br /> 1 1 D ,�✓� s v MI s o -7 s <br /> Ground 0'LS d P '-/8/p <br /> Depth to <br /> 5 81 3 At t •-� 7 8 <br /> limiting <br /> faC�Qr <br /> `j in. <br /> Remarks: <br /> Boring# <br /> OSA t4i <br /> 3 ` r[2V <br /> ccss . 4 <br /> Ground Q MP <br /> -� <br /> lam. a 4 (0 A . S' <br /> Depth to <br /> limiting <br /> factor <br /> _,_in. Remarks: <br /> CST Name (Please Print) Signature Telephone No. <br /> 04APPP 45, t"�"'�� 715- %6-467 <br /> Addr ss Date CST Number <br /> �loo �► S st�R I,Jt. 54$9'3 3.31-� Z2S SS d <br />