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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 j5 dcrr <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. Parcel I.D.# <br /> 034 <br /> 52D3 07-oAPPLICANT 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 /> ZTORMES ROW Govt.Lot 5 ��1/4$VJ 1/4,S70 T37�N R Ig E( W <br /> Property Owner's Mailing Address Lot# Block# d.Name or CSM# <br /> 4#757 RR LA?4Q AN/. 14a 27 <br /> s Y <br /> City State I Zip Code Phone Number <br /> CR 5;-r.9 I- ff 55 28 ( 6IZ )537- 5110 ❑ City El Village � Town Nearest Road <br /> til R ER <br /> XNew Construction Use: Residential/Number of bedrooms 3 Addition to existing building <br /> ❑Replacement Public or commercial-Describe: <br /> Code derived daily flow 4—gpd Recommended design loading rate JVA bed,gpd/ft2 NP trench,gpd/ft2 <br /> ., <br /> Absorption area required _bed,ft2 trench,ft Maximum design loading rate tr <br /> bed,gpd/ft2 - trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s) ft(as referred to site plan benchmark) <br /> Additional design/site considerations I CARL U PP07- Dd'S 17`15Parent material G LACI I L 1lRI t='r Flood plain elevation,if applicable YA ft <br /> S = Suitable for system I <br /> Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank <br /> U = Unsuitable for system I ❑ S U ❑S ] U ❑ S MU I ❑ S k U ❑ S iZ U S ❑ U <br /> SOIL DESCRIPTION REPORT <br /> Boris # Horizon Depth Dominant Color Mottles Structure GPD/ft2 <br /> Boring Texture Consistence Boundary Roots <br /> in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. Bed , Trench <br /> 1 1 �—S as 3 2 �-- G/ ��' s s ,,f •2 ' •3 <br /> 2 <br /> S-3q 5qg gm Oral svg 5L4 I M dv h 147 NP NY <br /> Ground <br /> a env. <br /> A <br /> n ft. <br /> Depth to <br /> limiting <br /> factor <br /> Remarks: <br /> Boring # <br /> 01 SVA 3 L r--- C < gh S J <br /> Z B 5 —J Cl M dvh gs M P NP <br /> *3 S Q y e- A S� S e c/ M dv h NP 0 <br /> Ground 4 4i7-V5 R 3 S 3 7 a <br /> elev. <br /> Depth to <br /> limiting <br /> factor <br /> JIL-in. Remarks: <br /> CST Name (Please Print) Signature Telephone No. <br /> 1CNt9RD aPlviJs S- 866- Y157 <br /> Address Date CST Number <br /> Z-760 K 1� �stER fit. 9'1523 -1 3470 <br />