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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 f Ili <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. <br /> Parcel I.D.# <br /> ©3,�, o q / 60o <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)). VM <br /> Property Owner (1 Property Location �� 1 <br /> G^J5 �� ! Z Govt.Lot Nv 1/4 1,1C'1,1C'1/4,Sa3 T 4/0 ,N,R /7 E(orJ� <br /> Property Owner's ailing Address7Lot Block# Subd.Name or CSM# <br /> C9 o s0 a 1, — %,ass �,9 k��_,'5�ore -s <br /> City State Zip Code Phone Number <br /> E] City El Village Town Nearest Road <br /> o 1,J-7:' s- o/ 1s <br /> c - )381{5"7 4�. ,dam <br /> V9-New Construction Use: Mflesidential/Number of bedrooms Addition to existing building ' <br /> 0 Replacement ❑Public or commercial-Describe: `— <br /> Code derived daily flow��r) gpd Recommended design loading rate 7_bed,gpd/ft2L_trench,gpd/ft2 <br /> Absorption area required _bed,ft2 _775 p_trench,ft2 Maximum design loading rate 2 bed,gpd/ft'-�_trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s) / 5- ft(as referred to site plan benchmark) <br /> Additional design/site considerations ` <br /> Parent material 4C-i3Ot- Flood plain elevation,if applicable AJA ft <br /> S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank <br /> U = Unsuitable for system S El M S ❑ U 9S ❑ U [As ❑ U )�S ❑ U ❑S Fi�U <br /> SOIL DESCRIPTION REPORT <br /> Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2 <br /> in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. Bed , Trench <br /> Ground311 <br /> . p S <br /> Depth to <br /> limiting <br /> factor <br /> Remarks: <br /> Boring # <br /> o2 2 <br /> ;;. <br /> co <br /> �'ZJ3 37 <br /> Ground <br /> elev. <br /> �ft. <br /> Depth to <br /> limiting <br /> factor <br /> >_jj-in. Remarks: <br /> CST Name (Please Print) Signature Telephone No. <br /> 415 <br /> a/� �s Syr1 <br /> Address Date CST Number <br /> a7A-v0 1722*76 <br />