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Wisconsin Department of Industry, SOIL AND SITE EVALUATION <br /> Labor and Human Relations Page of 3 <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 /50/Q/UC ! I <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. Parcel I.D.# <br /> o 3a - 5 33l0 -eD - 7ZI�9 <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 <br /> 7 LOGE/.� rJ - J0T/7r�At_S©N/ Govt.Lot s �U 1/4 /jV1/4,S P-7 T -/� ,N,R E(oryo <br /> Property Owner's Mailing Address Lot# Block# Subd.Name or CSM# <br /> /43-�;_ Mv9H7ZP11,!S�_D1 -9vC <br /> City State Zip Code Phone Number ❑ City ❑ Village Town Nearest Road <br /> ❑ New Construction Use: esidential/Number of bedrooms Addition to existing building <br /> Replacement Public or commercial-Describe: <br /> Code derived daily flow 45ngpd Recommended design loading rate bed,gpd/n2 g trench,gpd/ft2 <br /> Absorption area required 6q--3 _bed,n2 S(03 trench,ft2 Maximum design loadingrate bed,gpd/f2 <br /> trench,gpd/ft2 <br /> e <br /> Recommended infiltration surface elevation(s) ��- 7 t n(as referred to site plan benchmark) <br /> Additional design/site considerations tifOdJ <br /> Parent material 45�«1#z- bR I r T- Flood plain elevation,if applicable e, ft <br /> S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank <br /> U Unsuitable for system Ks ❑ U P S ❑ u I�S ❑ u PIS ❑ u EJS 0I ,U El �u <br /> SOIL DESCRIPTION REPORT <br /> Boring# Horizon Depth Dominant Color Mottles Structure GPD/ft2 <br /> Texture Consistence Boundary Roots <br /> in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. Bed , Trench <br /> -2,s ydz 3/.2 G 6 S s�L 6 a n4 .7 .S <br /> Ground <br /> eley. „ <br /> SfLn. <br /> Depth to <br /> limiting <br /> factor <br /> 7 74 in. <br /> Remarks: <br /> Boring If <br /> / O.,S.. -7, s u+2- 3/2 S G- 5 1 ,7 B <br /> ,.1. <br /> Ground <br /> elev. rr <br /> �G=3 n. <br /> Depth to ' <br /> limiting <br /> factor, nJ I CQ� P17- <br /> `7 - <br /> �n. Remarks: <br /> CST Name (Please Print) Si ure Telephone No. <br /> nt, /_iD r� - 'DF C--;>/5) a' -3So <br /> Address DaI6 CST Number <br /> 16 -1-21 r56. 54TH D 3T : 6vb3c aS�J <br />