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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. 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 "✓W t, <br />percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. # <br />04.2 ��� a i /off <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)). <br />Property Owner Property Location P C- <br />Govt. Lot 114 1/4,S,? 3 T Ye ,N,R 1,5— E (o <br />Property Owner's Mailing Address Lot # I Block# 1Xitift. Name or CSM# <br />3031 A .W C - .2 1 V �/6 P F-5— <br />City State Zip Code Phone Number ❑ City Elf <br />Village � Town Near9pt Road <br />i 0 t l44>-�e-- 1,04- 1 _$-Y7-0/ I ( ) zrAckso.j I oki <br />❑ New Construction Use: Residential / Number of bedrooms _ - Addition to existing building �! <br />5&Beplacement Public or commercial - Describe: <br />Code derived daily flow Yee gpd Recommended design loading rate 7 bed, gpd/ftz—.1-�trench, gpd/tt2 <br />Absorption area required d, ft2 07j trench, ft2 % <br />Maximum design loading rate bed, gpd/ft2 e r trench, gpd/112 <br />Recommended infiltration surface elevation(s) :3 ft (as referred to site plan benchmark) <br />Additional design/site considerations / <br />Parent material 61" /� ,C / A- �.l /' / 74"Flood plain elevation, if applicable ft <br />S - Suitable for System �Conventional Mound In -Ground Pressure ��A+,T-Grade System in Fill Holding Tank <br />U = Unsuitable for system V4 S ❑ U tR S ❑ U (,o S ❑ U 2q S ❑ U k ❑ U ❑ S <br />Boring # <br />a <br />Ground <br />elev. <br />17ZIT—ft. <br />Depth to <br />limiting <br />factor <br />27jQin. <br />Boring # <br />. 0I <br />Ground <br />ev. <br />/ ft. <br />Depth to <br />limiting <br />factor <br />";P-?^in_ <br />SOIL DESCRIPTION REPORT <br />Horizon <br />Depth <br />in. <br />Dominant Color <br />Munsell <br />Mottles <br />Qu. Sz. Cont. Color <br />Texture <br />Structure <br />Gr. Sz`%Sh. <br />Consistence <br />Boundary <br />Roots <br />GPD/ft2 <br />BBeed , Trench <br />Qr 4/ <br />7 <br />-71A <br />. <br />.ate+ <br />fJ <br />/ <br />Cam, <br />��,f/ <br />/l [� <br />t L /Y <br />Y� <br />,Y- 19Y' <br />-- <br />S <br />ZA5k <br />olydk <br />Remarks: <br />Remarks: <br />CST Name (Please Print) Siqnabire Telephone No. <br />Address t Date CST Number <br />'60-k -5I l S L I-CA� s—YE 2 > 15--l 9- 0 0 <br />