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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 /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. Parcel I.D.# <br /> oz z o <br /> APPLICANT INFORMATION - Please print all information. Reviewe b Date <br /> Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). <br /> i <br /> Property Owner Property Location <br /> rrz Govt.Lot 2— 1/4 1/4,S15 T 0 ,N,R Jr E(ore <br /> Property O er's Mailing Address Lot# Block# Subd.Name or CSM# <br /> qq If <br /> City State Zip Code Phone Number ❑ City ❑ Village 14 Town Nearest Road <br /> IFR-IrM05Aw i W1 1539 3 (W% )33 -60o6a I YACKSO4 1 KILKARE 0 <br /> KNew Construction Use: Residential/Number of bedrooms Z Addition to existing building <br /> ❑ Replacement ❑Public or commercial-Describe: <br /> Code derived daily flow 300 gpd Recommended design loading rate - 6 bed,gpd/ft2 -7 trench,gpd/112 <br /> Absorption area required qZq bed,ft2 31S trench,ft2 Maximum design loading rate •1 bed, d/fie <br /> n g g gp _ trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s) q4.7 Air. 1 6 .Z ft(as referred to site plan benchmark),, <br /> Additional design/site/considerations A59 41, Is AReIDS PReoeLk r IN All BoRiW iW to X .570 3�r� <br /> Parent material _ 6IALIAL D121f "- Flood plain elevation,if applicable NA It I . <br /> S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank <br /> U = Unsuitable for system ® S ❑ U Ns ❑ U Rs ❑ U K S El XS <br /> ❑ U ❑ S NUJ <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 /> Ground <br /> ev. <br /> 9jyft. <br /> Depth to <br /> limiting <br /> factor <br /> Remarks: f}l42$II & $0{�It/$O{�N� <br /> Boring # <br /> 2. Z S-71 7, R Rpf- ti w 1 <br /> Ground <br /> Depth to <br /> limiting <br /> factor <br /> >IL-in. Remarks: <br /> CST Name (Please Print) Signature Telephone No. <br /> KIc AED K� w�r�+d IS-866 - Y157 <br /> Address Date CST Number <br /> 2--77&0 9WX 3S I4i6Bsrrg 1.11- 3 $- 22-97 3670 <br />