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Wisconsin DepartmentIndustry, 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 u�.�rl-� <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. 161fl <br /> Pa of I.D.# <br /> APPLICANT INFORMATION- Please print all information- e`t <br /> P Reviewed by Date <br /> Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). �I—10-99 <br /> Property Owner Property Location V <br /> - Govt.Lot WY I�aM 1/4,S Z ij T ,N,R 161 E(oi� <br /> Prop rty Owner's Mailing Address Lot# Block# Subd.Name or CSM# <br /> 142.9 2 L O AcR£S <br /> City State Zip Code Phone Number <br /> S ( (� 03-�/ 53 ❑ City ❑ Village Town Nearest Road <br /> �oi LDOH <br /> New Construction Use: Residential/Number of bedrooms 3 Addition to existing building <br /> Replacement Public or commercial-Describe: <br /> Code derived daily flow._SSV gpd Recommended design loading rate •7 bed,gpd/ft2 •—Strench,gpd/ft2 <br /> Absorption area required &43 bed,ft2._7e'oQ trench,ft 2 Maximum design loading rate •7 bed,gpd/1`12 .'3 trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s) ft(as referred to site plan benchmark) <br /> Additional design/site considerations <br /> Parent material—GWUQI. 2LIFT' Flood plain elevation,if applicable A ft <br /> S Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank <br /> U Unsuitable for system 1 ®'S ❑ U IRJ S ❑ U ®S ❑ U 1 �s ❑ U I?S ❑ U ❑ S IOU <br /> SOIL DESCRIPTION REPORT <br /> Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary GPD/ft2 <br /> ry Roots <br /> in. Munsell Ou.Sz.Cont.Color Gr.Sz.Sh. Bed Trench <br /> 5 DYa 3 <br /> 2- S I[ 4 CS <br /> ' <br /> Ground AZ S �-� <br /> elev. <br /> (eft. 4• 7• n S 4 I I• a s t Nts 1 "� '1 -$ <br /> Depth to <br /> limiting <br /> f ct r <br /> Remarks: <br /> Boring# <br /> 2 2 5" 'V4 <br /> 3t 40-63 S <br /> 4 8 <br /> Ground 63. 9 7' C7-A R S' Q !� Y <br /> .alev. <br /> ft. <br /> Depth to <br /> limiting <br /> sin. Remarks: <br /> CST Name (Please Print) Signature Telephone No. <br /> AddressDate CST Number <br /> 60 w 3S F I-S�89 l-q SI <br />