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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. Cod <br /> Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County MIGINIAL <br /> include,but not limited to: vertical and horizontal reference point(BM),direction and <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. parcel I.D.# <br /> 012 420 07-741'"0' <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 CCC <br /> 69MAIJ Govt.Lott 1/4 1/4,S T N,R 1S E(or(; <br /> Property Owne s Mailing Address Lot# Block# Subd.Name or CSM# <br /> 14,01 MA44MA <br /> City State Zip Code Poone Number <br /> ❑ Ci El village � Town Nearest Road <br /> p rJ M�1• SS3z'1 %�31s quo AM <br /> ❑ New Construction Use: Residential/Number of bedrooms Z- Addition to existing building <br /> AReplacement Public or commercial-Describe: <br /> Code derived daily flow 300 gpd Recommended design loading rate •-I bed,gpd/f12 •% trench,gpd/ft2 <br /> Absorption area required +1A bed,n23-Z57 trench,n2 Maximum design loading rate -.1 bed,gpd/ft2 -'S trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s) R4-Ir ft(as referred to site plan benchmark) <br /> Additional design/site considerations <br /> Parent material CsLJVAAl_ Mlfr Flood plain elevation,if applicable NA ft <br /> S = Suitable for system I Conventional MoundIn-Ground Pressure AT-Grade System in Fill Holding Tank <br /> U = Unsuitable for system S ❑ U &S ❑ U Ks ❑ U 1 14 S ❑ U 11AS ❑ U ❑ S kj U <br /> SOIL DESCRIPTION REPORT <br /> Boring # Horizon Depth Dominant Color Mottles Structure GPD/ft2 <br /> in. Munsell Qu.Sz.Cont.Color Texture Gr. Sz.Sh. Consistence Boundary Roots <br /> Bed , Trench <br /> �`'t Ms .7 .8 <br /> Ground <br /> Qe,lev./ <br /> t. <br /> Depth to <br /> limiting <br /> f*�tg9r <br /> J (min. <br /> Remarks: 44.4 Q]!_X <br /> Boring# <br /> s Ds <br /> Ground <br /> I v. <br /> n. <br /> Depth to <br /> limiting <br /> )Mfa t <br /> in. Remarks: <br /> CST Name (Please Print) Signature Telephone No. <br /> 140pglds IS- 8a- 1 <br /> Address Date CST Number <br /> 2-7760 dwy --4.57- bkSamet_ .� Sq3 3 - to Do 857 <br />