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Wisconsin Department of Industry, 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 odq "qj -e— <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. Parcel I.D.# <br /> o/�,- 41Aa-7- 0V moo <br /> APPLICANT INFORMATION- Please print all information. Reviewed by Datep q <br /> Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). �J <br /> Property Owner Property Location Pr-r <br /> [ <br /> Govt.Lot.2 1/4 1/4,S,27 T 7 1 6,N,R /�� E(or� <br /> Property er's Mailing Address Lot# Block# Sabd.-Neme or CSM# <br /> a3 7S / `5p.ve- VY 14 6/ <br /> City State Zip Code Phone Number ❑ City ❑ village Town Nearest Road <br /> eA)4� I 5'V66'71 <br /> t.New Construction Use: Residential/Number of bedrooms Addition to existing building <br /> b Replacement ❑Public or commercial-Describe: <br /> Code derived daily flow Sod gpd Recommended design loading rate . Sbed,gpd/ft2_r�trench,gpd/ft2 <br /> Absorption area required gibed,ft2 S�)o trench,tt2 Maximum design loading rate // bed,gpd/ft2rench,gpd/fl2 <br /> q � <br /> Recommended infiltration surface elevation(s) / Si 5 ft(as referred to site plan benchmark) <br /> Additional design/site considerations <br /> Parent material C /1' /'/ Flood plain elevation,if applicable ,/'j1y�- 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 ❑ U 5 ❑ U 54 S El Jg S El lid ❑ U Elt�S JG7 U <br /> SOIL DESCRIPTION REPORT <br /> Boris # Horizon Depth Dominant Color Mottles Structure GPD/ft2 <br /> Boring Texture Consistence Boundary Roots <br /> in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. Bed Trench <br /> Ground <br /> elev. <br /> Depth to <br /> limiting <br /> factor <br /> �n. <br /> Remarks: <br /> Boring # o„ .S 1!5 S e` d><i CS eco og <br /> Ground <br /> elev. <br /> �n. <br /> Depth to <br /> limiting <br /> factor <br /> >85 in. Remarks: <br /> CST Name (Please Print) Signature Telephone No. <br /> G✓ho/c <br /> Address Date CST Number <br />