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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 -f <br /> include,but not limited to: vertical and horizontal reference point(BM),direction and $UR>JETI" <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. <br /> 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 DDD <br /> Property Location <br /> ERIE 1<15OPPLE G04,60t T q1 ,N,R jl' E(o& <br /> Property Owner's Mailing Address Lot# Block# Subd.Name or CSM# <br /> 5(o MILL.E(L -rkuNK AW <br /> City State Zip Code Phone umber ❑ City ❑ Village 14 Town Nearest Road <br /> LA UCA Mn/ 550011 - c2SIV-9143 I.S9 D. <br /> J�J New Construction Use: }xResidential/Number of bedrooms J Addition to existing building <br /> ❑ Replacement LJ Public or commercial-Describe: <br /> Code derived daily flowgpd Recommended design loading rate .7 bed,gpd/fl2�8-trench,gpd/fl2 <br /> Absorption area required bed,f12 S6's trench, 2 Maximum design loading rate <br /> p 9 9 bed,gpd/ft2_�trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s) 9 3•o Ac r *•q ft(as referred to site plan benchmark) <br /> Additional design/site considerations <br /> Parent material 1A(-119L UI21CT- Flood plain elevation,if applicable <br /> S Suitable for system Conventional Mound in-Ground Pressure AT-Grade System in Fill Holding Tank <br /> U Unsuitable for system S ❑ U S ❑ U S ❑ u X S ❑ u S ❑ u ❑ S P '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 /> 1 z b-5 ?• Ill NS <br /> � M dl � 2✓ .-i •8 <br /> 1S 7- R 'lam Ms d �- m 7 .S <br /> Ground <br /> elev. . <br /> Depth to <br /> limiting <br /> ctor <br /> in. <br /> Remarks: <br /> Boring # <br /> l D-S 1•S R 3 2 �'�' MS •� ,g <br /> 2- Z 85 K q1q �-- 145 .g <br /> Ground <br /> pe-heves. <br /> tl.vft. <br /> r <br /> Depth to <br /> limiting <br /> factor <br /> lin. Remarks: <br /> CST Name (Please Print) Signature Telephone No. <br /> 1cN of OMINS wl+.>,,lc( � /5- $/6- /S <br /> Address Date CST Number <br /> 27760 w 35 (,�f13srER I�JI. Sy8g3 6- z -R7 367o <br />