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Wisconsin Department of Industry, SOIL AND SITE EVALUATION Page_of <br /> Labor and Human Relations <br /> Division 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 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 /> Odg- /?6— 0 e7e <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(l)(m)). 7 ZO- <br /> Property Owner Property Location <br /> j ra CI i o /ll jo h Govt.Lot Vj-,iA 7 1/4 114,S36 T �40,N,R /�Z E(ordD <br /> Property Owner's Mailing Address Lot# Block# Subd.Name or CSM# <br /> 8 /V/// Rd, 1111,14 IC51Y337v 1 - a P. G 3-6" 5e <br /> C,iitt/y j� State zip Code Phone Number Ne/aar Roa/d� <br /> /� N ss30s- (61QQ38-1008 ❑ °i� ❑)V'II a Town (J/R C/c/KY d- <br /> ❑ New Construction Use: [Pli esidential/Number of bedrooms 3 Addition to existing building <br /> ['Replacement ElPublic or commercial-Describe: <br /> //����—j�� <br /> Code derived daily flow�gpd Recommended design loading rate s bed,gpd/fl2 `— trench,gpd/ft2 <br /> Absorption area required 900 bed,ft2 trench,ft Maximum design loading rate e 7 bed,gpd/ft2 trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s) 74 d0 97' 00 ft(as referred to site plan benchmark) <br /> Additional design/site'considerations %! SS t C O ' i dl-�a 11l0)r <br /> Parent material (1�/2GT t / / Flood plain elevation,if applicable /r ft <br /> S = Suitable for system Conventional ,M.,ouund In-Ground Pressure Al-Grade System in Fill Holding rTaannkk <br /> U = Unsuitable for system ®#t ❑ U L'7 S ❑ U LIS ❑ C 11J 5 ❑ C ❑ S LrT D ❑ S II�J u <br /> SOIL DESCRIPTION REPORT <br /> Horizon Depth Dominant Color Mottles Structure GPDe <br /> Boring# Texture Consistence Boundary Roots <br /> in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. Bed Trench <br /> o -'S �, f 3/n f <br /> S` 7Ground -S /STTi9ISSs - 7'R --J. <br /> Depth to <br /> limiting <br /> factor <br /> >20 1n. <br /> Remarks: <br /> Boring# / 0-S 7.S 3 — S O— S h1 J ht • 7 <br /> 6 V42- 1 <br /> 7 If s _s 142 ' <br /> Ground 70 7 s� S f / • 7 <br /> Depth to ' <br /> limiting <br /> factor <br /> >-70-in. Remarks: <br /> CST Nape (Please Print) Signature Telephone No.C <br /> Address Date CST Number <br />