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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 U <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. parcel I.D.# <br /> i /) - �S-D/ 760 <br /> APPLICANT INFORMATION- Please print ail information. Rev,.i.evj9d by f/ 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 /> Govt.Lot 1/4 1/4,So2S T YD ,N,R /S E(or)Z <br /> Property Owner's Wiling Address I-c-Dne Lot If Block# I Subd.Nnnra or CSM# <br /> a J"5:-V.4 / — V ,O x 3 9' <br /> City State Zip Code Phone Number ❑ City ❑ Village If Town Nearest Road <br /> So s1 P�/ Intl sso7s( �4cfs a� s,�-,��,� ��c. <br /> ❑ New Construction Use: Residential/Number of bedrooms Addition to existing building <br /> Replacement Public or commercial-Describe: <br /> Code derived daily flow v gpd Recommended design loading rate � gybed,gpd/ft2 ✓ y trench,gpd/ft2 <br /> Absorption area required d bed,tt2 S0y trench,It <br /> 2 <br /> Maximum design loading rate e-S bed,gpd/ft2 ' 6 trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s) 95e 7 ft(as referred to site plan benchmark) <br /> Additional design/site considerations <br /> Parent material <?�i4C;"q-/ 0//^i f Flood plain elevation,if applicable <br /> S Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank <br /> U unsuitable for system ®s ❑ u 24,S El1- <br /> U S E] U KS El LAS El ❑S U <br /> SOIL DESCRIPTION REPORT <br /> Boring # Horizon Depth Dominant Color Mottles Structure GPD/ft2 <br /> in. Munsell Ou.Sz.Cont.Color Texture Gr.Sz.Sh. Consistence Boundary Roots <br /> e`�= Bed Trench <br /> a 3,� <br /> Ground �.� i�� — S <br /> eleev 7 <br /> rn'i ft. <br /> Depth to <br /> limiting <br /> factor <br /> j�in. <br /> Remarks: 3 -7,0CAw-5 0 ZAs e- Z.a// s: z 'e S/ 7 vs 'P% <br /> Boring # 3 <br /> -y ,s �s6K c ,cm 8 <br /> 8d ,Sys' <br /> Ground <br /> elev. <br /> Depth to <br /> limiting <br /> factor <br /> 'jLO in. Remarks: ) �^��/y1�o,,. 6As�6a/� S,`z� S/ 7.53l1 <br /> CST Name (Please Printt)) Signature Telephone No. / <br /> Address 10, Date CST Number <br />