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Labor and Department of Industry, SOIL AND SITE EVALUATION <br /> Labor and Human Relations <br /> Division of Safety and Buildings in accordance with s. ILHR 83.09,Wis. Adm. Code Page—of <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. U <br /> Parcel I.D.# <br /> APPLICANT INFORMATION- Please print all information. 037- 51W ©l 416 <br /> Personal information by Date <br /> you provide maybe used for secondary purposes(Privacy Law,s.15.04(1)(m)). <br /> Property Owner Property Location <br /> J Govt.Lotr_1/4 At 1/4,S ?;2 T ' ,N,R (� E(or� <br /> Property Owner's Mailing Addre Lot# Block# Subd.Name or CSM# <br /> 1?o_ F <br /> city State Zip Code Phone Number ❑ City ❑ village Town Nearest Road <br /> lid I 5's <br /> New Construction Use: LgResidentiall/Number of bedrooms 3 Addition to existing building <br /> ❑ Replacement LJ Public or commercial-Describe: <br /> Code derived daily flow +Z gpd Recommended design loading rate - bed,gpd/ft2 _trench,gpd/ft2 <br /> Absorption area required bed,ft2 5L3 trench,ft2 Maximum design loading rate •7 bed, /ft2 -g <br /> n gpd trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s) 9y.3 ft(as referred to site plan benchmark) <br /> Additional design/site considerations <br /> Parent material AIACIAL 0)2,Kr <br /> Flood plain elevation,if applicable Np ft <br /> S = Suitable for system Conventional Mound In-Ground Pressure I AT-Grade System in Fill Holding Tank <br /> U Unsuitable for system ® S El S El S El 5a S EJU S El ❑ S VU <br /> SOIL DESCRIPTION REPORT <br /> Boring # Horizon Depth Dominant Color Mottles Structure <br /> in. Munsell Qu.Sz.Cont.Color Texture Consistence Boundary Roots GPD/ft2 <br /> 14 - <br /> Gr.Sz.Sh. Bed Trench. 7 2 A& s Ground 7 ,9 <br /> " 4 ' <br /> Depth to <br /> limiting <br /> factor <br /> in. <br /> Remarks: <br /> Boring# <br /> M CS 2co 1 <br /> 2 Z 47 5 K44 iA1 4 2cc ? b <br /> 7 S R 4J& rim pts 1r`I <br /> Ground 4 (&r*73 7. i----� M5 <br /> �l�evp <br /> Depth to <br /> limiting <br /> factor <br /> 7-Uin. Remarks: <br /> CST Name (Please Print) Signature Telephone No. <br /> 1_4A1Z° IS- 866- 4157 <br /> Address 71S <br /> ICn Date /t,� CSSZT�N7umbecrr <br /> 277�o0 �w Wr=47�tGQ �� - Vii/ Lf-_5OS7 <br />