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Wisconsin Department of Commerce SOILAM SrTE EVALUATION Page_of— <br /> Division Of*wety and Buildings in accordance with s.ILHR 83.09,Wis.Adm.Code <br /> Bureau of Integrated Services <br /> County <br /> Attach complete site plan on paper not toss than a 12 x 11 inches in size. Plan must <br /> include,but not limited to: vertical and horm)ntal referance Point(BM)•direction and u <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. 32 I.D.# O' <br /> Date <br /> APPLICANT INFORMATION- Please Print all Infomlation. <br /> Reviewed by <br /> Personai inkwnation you proms may be used for secondary Pum( � 15.04(1)(m)). <br /> PropeAy Location (or <br /> Property owner Govt.Lot W 1/4 E 1/4,S 4 T Q-1 NR E <br /> s <br /> G Lot R Blockit Subd.Name or CSMff <br /> Properly Owners Mailing Address 13' <br /> 14 FT -akf e <br /> Phone Number ❑ CRY <br /> ❑ Illage Town Nearest Road <br /> City State Zip Code R . <br /> o W S4a ( �S )247-5/0o vJ s <br /> Addition to existing building <br /> New Constriction Use: Residential/Number of bedrooms <br /> Replacement Public or corrunential-Describe: ' $ <br /> Recommended design loading rate '� _bed.giw,��a trench,9Pr <br /> Code derived daily flow 3D 0 gpd --T bed g 2 ,$ trenCti,gpollt2 <br /> Absorption area required_�.ft2 '57 UenCh.n2 Maidmum design loading rate <br /> on(s) <br /> q4 I n(as referred to site plan benchmark) <br /> Recommended infiltration surface elevati <br /> Additional designlsite considerations NA ft <br /> UAL QI Flood plain elevation. applicable <br /> Parent material in FII Folding Tank <br /> J--Mn�venbcnad Mound System �S ® U <br /> S = Suitable for system SUDOS OU ❑ S ❑ UU = Unsuitablefor system ❑ U <br /> SOIL DESCRIPTION REPORT GPD/ft2 <br /> Structure Consistence Boundary Roots Bed ,Trench <br /> Boring# Horizon Depth Dominant Cour mottles Texture Gr.Sz.Sh. <br /> in. Munsell Qu.Sz.Cont Odor <br /> I b-(a . a 3 2 r� Ms 0 <br /> s <br /> 7. 4' MS <br /> l— W r <br /> Ground 7 7•S Q 44 <br /> elev. <br /> Depth to <br /> limiting <br /> factor <br /> Remarks: ca <br /> Boring# <br /> 2 2 - 4 <br /> Ground <br /> el v. <br /> ft. <br /> Depth to <br /> limiting <br /> fc1r <br /> '1in. Remarks: Tphone NO. <br /> CST Name (PleSignature <br /> ase Print) �s- g�'.aTu <br /> i (�Q n O p I s Date CST Number <br /> Addr ssal76 0 �{,�Y -SS Vj6j%M91W1 Z3- 9 g <br />