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Wisconsin Department of Industry, SOIL AND SITE EVALUATION Page of <br /> Labor and Human Relations <br /> Division of Safety and Buildings in accordance with s. ILHR 83.09, W is. <br /> Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must County <br /> include,but not limited to: vertical and horizontal reference point(BM),direction and <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. Parcel I.D.# <br /> ON- 03 <br /> APPLICANT INFORMATION- Please print all information. Reviewed Date <br /> Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). I e[ 414 <br /> Property Owner Property Location <br /> An� Govt.Lot 1/4 1/4,ST ,N,R E(or)E) <br /> Property Owner's Mailing Address Lot# Block# Subd Name or CSM# <br /> '/COY s 7- ./ 7e — �i Z-// <br /> City State Zip Code Phone Number Nearest Road yy q6 <br /> e r fe GJ.� (�/S)�Si - >'s'i Ll Ciry L ❑ Village o ovrt' c rnnibAr <br /> ❑ New Construction Use: Residential/Number of bedrooms �_ Addition to existing building <br /> ®•Replacement ❑Public or commercial-Describe: <br /> Code derived daily flow O 0 gpd Recommended design loading rate r 7 bed,gpd/4-- -,E—trench,gpd/1`12 <br /> Absorption area required-ya57—bed,n2 -7 �>3 trench,n2 Maximum design loading rate bed,gpd/flz_ trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s) �G `� it(as referred to site plan benchmark) <br /> Additional design/site considerations — <br /> Parent material C�/.9 c ,'�_.,/ !I/,- Flood plain elevation,if applicable n <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 as ❑ u ® s ❑ u s ❑ u ❑ s �.0 <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 /> 13 0--7 7,s 7,f J r S <br /> a 1 /s <br /> Ground <br /> •.� Sa' .7 /1 S/E S CSS .S 'ccs i , 8' <br /> elev <br /> fin• ?65 7,s . ,4 — f 6 ✓ / s fi <br /> Depth to <br /> S 6S)x <br /> limiting <br /> factor <br /> erin. <br /> F4- <br /> Remarks: <br /> Boring# <br /> C3 �'�` /S s 41 <br /> 3 7.�: V 6 5 <br /> Ground �6 ¢S <br /> elev. <br /> n. <br /> Depth to 44 <br /> limiting p <br /> factor ISS /sgi(� <br /> _Jin. Remarks: <br /> CST Name (Please Print) Signature Telephone No. <br /> Address r Date CST Number <br /> i <br />