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Wisconsin Department of Industry, SOIL AND SITE EVALUATION <br /> Labor and Human Relations Page of <br /> Division of Gafety and Buildings in accordance with s. ILHR 83.09, Wis. <br /> Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must County \I <br /> include,but not limited to: vertical and horizontal reference point(BM),direction and e <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. Parcel I.D.p <br /> 01 - - <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)). Q IO .c)y-c+1. — <br /> Property Owner Property Location <br /> /n'f r k ke .S Govt. Lot /1)L-114 /U&A/4,S 99 T3Y ,N,R/o E(org ,, <br /> Property Owner's Mailing Address Lot# Block# Subd.Name or CSM <br /> 76y e w v-l� st — ..r- <br /> City ,. State Zip Code Phone Number k o/ a&-e Nearest Road <br /> PromsCC//,�JW 3 off/ ( )„2t1Q-S3�?Q ❑ City ❑ Village [a Town Q f LIT <br /> `/ <br /> / <br /> ® New Construction Use: ®Residential/Number of bedrooms �9_ Addition to existing building <br /> ❑ Replacement ❑Public or commercial-Describe: <br /> Code derived daily flow U gpd Recommended design loading rate be ,gpd/ft2 . 8trench,gpd/142 <br /> Absorption area required ya bed,ft2 loading i d/nz trench, Maximum design fiz i <br /> qqy g g rate be ,gptrench,gpdttt2 <br /> Recommended infiltration surface elevaton(s) LJ n(as referred to site p an benchmark) <br /> Additional design/site considerations '— <br /> Parent material 6Z/,4-c- Cj r,/,I' Flood plain elevation,if ap plicable '-U ff n <br /> S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank <br /> U = Unsuitable for system Ks Elu ;0 s ❑ u Rs ❑ u t ] s ❑ u ®'s ❑ u ❑ S ®-u <br /> SOIL DESCRIPTION REPORT <br /> Boring# Horizon Depth Dominant Color Mottles V <br /> Structure Consistence Boundary Roots GPD/ft2 <br /> in. Munsell Ou.Sz.Cont.ColorGr.Sz.Sh. Bed Trench <br /> l l °`7 .S R%a —7 7,s /qP� - ��6 �rtrGroelevund 3-8 7 7 t �6 OS �' /h / -` • 7 .$' <br /> Depth to <br /> limiting <br /> factor <br /> 7!o in. <br /> Remarks: <br /> Boring# <br /> ✓fes c s 3 d <br /> Sc7. s ,P <br /> Ground <br /> elw <br /> Depth to <br /> limiting <br /> factor , <br /> Remarks: 61 <br /> CST Name (Please Print) Signature p Telephone No. <br /> Address Date CST Number <br /> Po BoX �/Y S.i e lJ� s 5�87z /o/Z' '-93' �� <br />