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Labor and <br /> Department i 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 e <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. parcel I.D.# <br /> �1�0- 31 1- 0/-8c)5 <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)). ` ^/ Iy q <br /> Property Owner Property Location c <br /> 2 G FC^j rj @✓-' Govt.Lot Se f 1/4/U W1/4,S 9 T yd ,N,R E(or W� <br /> Property Owners Maili Address Lot# Block# Subd.Name or CSM# <br /> City80 k Co. eJ, U — <br /> rJ� u/ — <br /> State Zip Code Phone Numbe 7 ❑ City ❑ Village Town Nearest Road <br /> 40.r sY�3o ( )81_ o <br /> 1[1.New Construction Use: Nesidential/Number of bedrooms �_ Addition to existing building <br /> ❑ Replacement ❑Public or commercial-Describe: <br /> Code derived daily flow 1:5-0 gpd ^� Recommended design loading rate r bed,gpd/ft2 i b trench,gpd/ft2 <br /> Absorption area required l00 bad,ft2 or trench,ft2 Maximum design loading rate/Zbed,gpd/ft2-z-?—trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s) 9s-, 9 ft(as referred to site plan benchmark) <br /> Additional design/site/co�nsiderations 1 <br /> Parent material C T1,4 C /',+ I Flood plain elevation,if applicable "-Z1 ft <br /> S = Suitable for system Fdonventional rMound In-Ground Pressure AT-Grade System in Fill Holding Tank <br /> U = Unsuitable for system Elor& <br /> U � - ❑ U Di�z ❑ U ZS ❑ U 4 -S ❑ U ❑ S KU <br /> SOIL DESCRIPTION REPORT <br /> Boring# Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2 <br /> in. Munsell Du.Sz.Cont.Color Gr.Sz.Sh. Bed Trench <br /> 1W 1 0 P3i _ <br /> -a1 .�syy� y 15 ImA s -5 .-7 ,S <br /> G-eleound ��6� -'/�� <br /> v. <br /> Depth to <br /> limiting <br /> fa for <br /> Remarks: ��l 6 ,4 w�S �4 f" .sy it _ 6 Z r/ <br /> Boring # I 0-7 Sy <br /> 5' s c .m .op <br /> �j, <br /> Ground <br /> ev. <br /> �ft. <br /> Depth to <br /> limiting / <br /> factor <br />? Sin. Remarks: ff+ <br /> CST Name (Please Print) SignatureTelephone No. <br /> Address C Date CST Number <br />