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Wisconsin Department of Industry, SOIL AND SITE EVALUATION Page_of <br /> tabor and Human Relations <br /> Qivision of Safety and Buildings in accordance with S. ILHR 83.09,Wis. <br /> Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must <br /> County <br /> include,but not limited to: vertical and horizontal reference point(BM),direction and SURAlOr <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. Parcel I.D.# <br /> ^ <br /> 9Y S3 700 <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)). �j �� y <br /> Property Owner Property Location x;27'eflj�,K/ <br /> 5 Govt.Lot 1/4 1/4,S Z$ T 4� ,N,RT6Whi -0e (� E(or)� <br /> Property Owners ailing Address Lot# Block# Subd.Name or CSM# <br /> 551 R1�l - /® �. �'r �s /s � �IS,���6 r, <br /> City State Zip Code Phone Number 5 l55 Nearest Road <br /> F1 J�1$36 ( J� )�� ❑ city 1 vilage � Town MgrrJ 5T <br /> New Construction Use: ❑Residential/Number of bedroomsAddition to existing building <br /> r <br /> Replacement Public or commercial-Describe: 5 %jif3 0 Z EM P 1b W dAm LA_ 2 S 5Eftr_EtR0qRLL <br /> � ,j Recommended design loading rate . S bed,gpd/n2 .G trench,gpd/ft2 <br /> Code derived dally flow �1L'��,.,—^ gpd <br /> Absorption area required "[0 bed,ft2 400 trench,n2 Maximum design loading rate bed,gpd/fl2 • (P trench,gpd/112 <br /> Recommended infiltration surface elevation(s)q-I 0 n(as referred to site plan benchmark) <br /> Additional design/site considerations <br /> Flood plain elevation,if applicable AIA -ft <br /> Parent material GLACI►JL n1Zl f—r <br /> S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holds g I aanu <br /> CR U = Unsuitable for system ®S ❑ U ® S ❑ U S ❑ U ® S ❑ U 1L� S ❑ U <br /> SOIL DESCRIPTION REPORT <br /> Horizon Depth Dominant Color Mottles Structure GPD/ft2 <br /> Boring# P Texture Consistence Boundary Roots Bed , Trench <br /> in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. <br /> OMSTZ MS <br /> Ground L{ K <br /> �elev. <br /> Depth to <br /> limiting <br /> factor <br /> lin. <br /> Remarks: <br /> Boring# S <br /> 1 0.5 P,-3 i �- <br /> 2 <br /> Z .s . 6 <br /> R � <br /> Ground <br /> Depth to <br /> limiting <br /> in. Remarks: ?JD <br /> Sig Telephone No. <br /> ST Name (Please Print) / 157 <br /> «}Alzv i n/5 <br /> Date CST Number <br /> dress <br /> 27 /0 35 (�1E8s7E� lJ�. ��893 I- I9- 96 6 ° <br />