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Wisconsin Department of Industry, SOIL AND SITE EVALUATION <br /> J_abor 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 <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. Parcel I.D.# <br /> o I 2 Sla<9 <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 Omer Property Locabon c <br /> 131-/�,,) A cj Govt.Lot _-cv 1/4 3"(5-1/4,S 3o T f-10 ,N,R '/ �' E(or)9 <br /> Property Owner's Mailing Address Lot# Block# Subd.Name or CSM# <br /> Cityll State Zip Code Phone Number El city ❑ village 'g Town Nearest Road <br /> G'r.tA)15�41 w D ( ) 3- 039 G✓e s� A i/��� ilJai�.4 <br /> ❑ New Construction Use: CgResidential/Number of bedrooms -3 Addition to existing building <br /> 0 Replacement ❑Public or commercial-Describe: <br /> Code derived daily flow yap gpd / Recommended design loading rate 17 bed,gpd/ft2 i0p trench,gpd/ft2 <br /> Absorption area required dY.Y bed,ft2 s�O3 trench,h,ft2 Maximum design loading rate_Lbed,gpd/ft2,trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s) 9 Y- / ft(as referred to site plan benchmark) <br /> Additional design/site considerations <br /> Parent materialr / <br /> C��LI-C/.4� �/�/ T t Flood plain elevation,if applicable /`Z/74- ft <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 ,KS ❑ U ,n.5 ❑ U t,s ❑ U ❑ S 9U <br /> SOIL DESCRIPTION REPORT <br /> Boring# Horizon Depth Dominant Color Mottles Structure GPD/ft2 <br /> Texture Consistence Boundary Roots <br /> in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. Bed , Trench <br /> l 1)15 d( <br /> Ground 37, <br /> elev. <br /> Depth to <br /> limiting <br /> factor <br /> Remarks: <br /> Boring# <br /> ,P <br /> 71,Fye C <br /> Ground <br /> elev. <br /> ft' <br /> Aft0 <br /> Depth to <br /> limiting <br /> factor <br /> >Min. Remarks: <br /> CST Name (Please Print) Signature Telephone No. <br /> Address Date CST Number <br />