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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 andtA9— g'I r <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. Parcel I.D.# <br /> 0a0-qa co- D--1 SSD <br /> APPLICANT INFORMATION- Please print all information. Reviewed by Date Q <br /> Personal infomiation you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). I zk <br /> �() <br /> Property Owner Property Location <br /> '::S-of4Ot4Y McWT'UR O(. Govt.Lot 1/4 1/4,S iq T40 ,N,R E(oe <br /> Property Owner's Mailing Address Lot# Block# I Subd.Name or CSM# <br /> b 2 (oma ST- 24 5n7.i1 s19, CA40RE DIV. <br /> City State Zip Code Phone Number ❑ City ❑ Village gh Town Nearest Road <br /> uv /J IWI 15401(o jQ15 ) - OA91AOD fAF-r- sr- <br /> New Construction Use: [)f Residential/Number of bedrooms 3 Addition to existing building <br /> Replacement ❑Public or commercial-Describe: <br /> Code derived daily flow_4450 god Recommended design loading rate bed,gpd/ftz -_-, trench,gpd/ftz <br /> Absorption area required Nfk _bed,ft2 jp43 trench,ft2 Maximum design loading rate bed,gpd/it2 '7 trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s) q6.1ft(as referred to site plan benchmark) <br /> Additional design/site considerations <br /> Parent material &tin►LtflL ` ITZiVr+ Flood plain elevation,if applicableNb ft <br /> S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank <br /> U = Unsuitable for system ®S ❑ U ® S ❑ U Ns ❑ U 1a s ❑ U 'R S ElU ❑s -N U <br /> SOIL DESCRIPTION REPORT <br /> Boring # Horizon Depth Dominant Color Mottles Structure GPD/tt2 <br /> Texture Consistence Boundary Roots <br /> in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. Bed Trench <br /> Z r--1 s o Cs l✓� <br /> 2 5-55 7 ,� 6 �� ,Ns ,crl C /Pa . <br /> Ground 3 <br /> elev. <br /> ft. <br /> Depth to <br /> limiting <br /> fa or <br /> ) <br /> 70 in. <br /> Remarks: <br /> Boring # <br /> 2 5-5p7sum 4 <br /> 3 4 <br /> Ground <br /> v. <br /> Depth to <br /> limiting <br /> fact <br /> in. Remarks: <br /> CST Name (Please Print) Signature Telephone No. <br /> cl+la RO 14DP9145 946- 4-157 <br /> Address Date CST Number <br /> 2-77&0 LJI- 5450 7- 12-00 2:Z5%—<1 <br />