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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 <br /> pe cent slope,scale or dimensions,north arrow,and location and distance to nearest road. parcel I.D.# <br /> 032 520$ 160 <br /> APPLICANT INFORMATION- Please print all information. Reviewe�/ty Date 9 `� <br /> Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). Y9 / <br /> Property Owner Property Location <br /> RKRAM612, Govt.Lot 1/4 1/4,S D T ' ,N,R �s E(orn <br /> Property O er's Mailing Address Lot# Block# Subd.Name or CSM# $.4 6 <br /> 177-0LOUi5 Lt)- VOL.. ZS P. 3`f LRE <br /> City State Zip Code Phone Number ❑ City ❑ Village ® Town Nearest Road <br /> gils-rig4s IM141550331 ( 315 )"- 37171- s 1518 P1,65 LY- RD- <br /> ❑ New Construction Use: 9 Residential/Number of bedrooms 3 Addition to existing building <br /> CR Replacement ❑Public or commercial-Describe: <br /> Code derived daily flow qM gpd Recommended design loading rate •7 bed,gpd/ft2 •g trench,gpd/ft2 <br /> Absorption area required 03 bed,ft2 S(D!!) �-t-trench,tt2 Maximum design loading rate . bed,gpd/ft2 •8 trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s)01S.q ft(as referred to site plan benchmark) <br /> Additional design/site considerations <br /> Parent material GLA OAL DRIFT' Flood plain elevation,if applicable NQ 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 9 S ❑ U 5� S ❑ U ®S ❑ U ❑S MU <br /> U <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 /> 1 0-S a _34 <br /> �— s '1 . 8 <br /> 2- •72 7-SVO 4A '�. H3 .7 B <br /> Ground <br /> lev <br /> Depth to <br /> limiting <br /> factor <br /> Remarks: PIANO Agm Soaloc <br /> Boring# <br /> I -5 TCYR S/7— <br /> �— S "► S <br /> 2 Z <br /> S-72 7• A <br /> Ground <br /> ,Aeve <br /> 1'p•D ft. <br /> Depth to <br /> limiting d <br /> factor <br /> Min. Remarks: 9660 A2499 2090k r <br /> CST Name (Please Print) Signature t6lep ne N <br /> cWRQ /S- <br /> Addre s Date CST Number <br /> ;7760 w .35 R �✓l • 5893 - $- q720 <br />