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Wisconsin Department of Industry, SOIL AND SITE EVALUATION 01-/-`1/ ra. <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 URh�ar <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. Parcel I.D.# <br /> ora �7aS- 4s00 <br /> APPLICANT INFORMATION - Please print all information. Reviewed by Date <br /> Personal infomlation you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). 10-15-9y <br /> Prope Owner Property Location <br /> tL <br /> QuIOL O Govt.Lot 1/4 1/4,S y T N,R S E(or W <br /> Property Owners Mailing Address Lot# Block# P6�296' <br /> or CSM# <br /> $ 9800%4 Q 15. `/ <br /> City State Zip Code Phone Numb <br /> D � I ( (`, er /` El City El Village �' Town Nearest RoadI�U !� <br /> J —ICIJ 4 �E _ �I�- <br /> I New Construction Use: Upesidential/Number of bedrooms Addition to existing building <br /> ❑ Replacement Public or commercial-Describe: <br /> Code derived daily flow 300 gpd Recommended design loadingrate bed,gpoli2• $n trench,gpd/ie <br /> Absorption area required +W1 bed, <br /> ft23n5' trench,ft2 Maximum design loading rate •'t bed,gpd/fl2 •8 trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s)�_ .8� ft(as referred to site plan benchmark) <br /> Additional design/site considerations <br /> Parent material GLACIAL 091ET Flood plain elevation,if applicable NA ft <br /> S = Suitable for system roCoonventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank <br /> U = Unsuitable for system ICJ S ❑ U ®S ElU Vs ElU 10S ❑ U 9 S ❑ U ❑ S NU <br /> SOIL DESCRIPTION REPORT <br /> Boring# Horizon Depth Dominant Color Mottles Structure GPD/ft2 <br /> in. Munsell Qu.Sz.Cont.Color Texture Gr.Sz.Sh. Consistence Boundary Roots <br /> Bed Trench <br /> -7 $ <br /> 5.46 6 M 7 1u► . 7 ' .8 <br /> Ground . 7 , <br /> rev. <br /> waft. <br /> Depth to <br /> limiting <br /> fqS4or <br /> Remarks: <br /> Boring # <br /> 3 7-9 <br /> Ground <br /> elev <br /> Depth to <br /> limiting <br /> fa <br /> in. Remarks: <br /> CST Name (Please Print) Signature Telephone No. <br /> LARD PK/43 lS- - <br /> Address Date CST Number <br /> 35 3 0- - 5- <br />