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Wisconsin Dgpartment of Commerce SOIL AND SITE EVALUATION <br /> Division of Safety and Buildings Page of <br /> Bureau of Integrated Services 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 1 U y <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. Parcel I.D.# <br /> 0(2 - a> 3/.- 63 - ao0 <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)). I AL S�� I �a-/,72 <br /> Property Owner / Property Location t <br /> �/ <br /> Ve�i'IJ / L /L rn J Govt.Lot S W 1/4 S 1/4,S 3 !) T a e ,N,R 7 E(orkW) <br /> Property Owner's Mailing Address Lot# Block# Subd.Name or CSM# <br /> City State Zip Code Phone Number <br /> ❑ City El Village CO Town Nearest Road <br /> LM im cw 61;s Al I3 �3 ( ) /�' <br /> ❑ New Construction Use: ®Residential/Number of bedrooms Addition to existing building <br /> ® Replacement ❑Public or commercial-Describe: <br /> Code derived dailyflow O = 7 bed, /ft2 <br /> � gpd Recommended design loading rate gpd trench,gpd/ft2 <br /> Absorption area required 'bed,n2 3 trench,ft Maximum design loading rate i Z bed,gpd/fl2 _t_trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s)� � ft(as referred to site plan benchmark) <br /> Additional design/site considerations <br /> Parent material G /,c. G I q.T a,;{f Flood plain elevation,if applicable 161 wft <br /> S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank <br /> U = Unsuitable for system [31 S ❑ u 17 s ❑ u p S ❑ U ❑S ® u ❑ s S;u ❑S IN U <br /> SOIL DESCRIPTION REPORT <br /> Boring# Horizon Depth Dominant Color Mottles Structure GPD/ft2 <br /> Texture Consistence Boundary Roots <br /> ,,,.. <br /> in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. Bed , Trench <br /> 5 ,r) J u <br /> Ground <br /> elev. <br /> Depth to <br /> limiting <br /> factor <br /> 7 z in. <br /> Remarks: <br /> Boring# <br /> 2 Py a ; <br /> D S y a psr O <br /> ., <br /> Ground <br /> �ev� <br /> ft. 114 re. <br /> i 9 <br /> Depth to <br /> limiting <br /> fa or <br /> in. Remarks: <br /> CST Name (Please Print) SignatureTelephone No. <br /> o� <br /> Address bate -e6T Number <br /> Leti 0 2Q L 19 Z <br />