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Wisconsin Department of Commerce SOIL AND SITE EVALUATION <br /> Division of Sjtfety 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 &Q <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. Parcel I.D.# <br /> D20 qZ,2S OZ 00 <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)). a i j <br /> Property Owner Property Location G <br /> S©Ad r(„E I:jC,UAC1.. rU Govt.Lot 1/4 1/4,S 37— T L� ,N,R E(o W <br /> Property Owner's Mailing Address Lot# Block# Subd.Name or CSM# <br /> 30(a - 30'''' Sr. N �?__ I_:S - Rl6s QST. <br /> City State Zip Code Phone Number ❑ City ❑ Village 'Y1 Town Nearest Road <br /> 3TIL0dAT Mt 55082 c SI " <br /> New Construction Use: Pesidential/Number of bedrooms Addition to existing building <br /> Replacement ❑Public or commercial-Describe: <br /> Code derived daily flow gpd Recommended design loading rate_ bed,gpd/fF trench.gpd/ft2 <br /> Absorption area required I'o43 bad,ft2 Sias trench,n2 Maximum design loading rate bed,gpd$ a trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s)�3-�n Ari 74 9 ft(as referred to site plan benchmark) <br /> Additional design/sitcoAqnsideration Isr� 11 <br /> Parent material Flood plain elevation,if applicable NT1 ft <br /> S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank <br /> U = Unsuitable for system XS ❑ U )ZS ❑ U 0 S ❑ U 10S ❑ U 'WS ❑ U ❑s 'zu <br /> SOIL DESCRIPTION REPORT <br /> Boring# Horizon Depth Dominant Color Mottles Structure GPD/ft2 <br /> Texture Consistence Boundary Roots <br /> in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. Bed Trench <br /> 1 D-5 SQ32 6 -- #4 <br /> 2 5- I 7 R s co 7 <br /> Ground <br /> aelev. <br /> 6�ft• <br /> Depth to <br /> limiting <br /> factor <br /> Remarks: <br /> Boring If <br /> 2 2 ��� .7 .8 <br /> Ground <br /> I <br /> ft 0 <br /> Depth to <br /> limiting <br /> factor <br /> in. Remarks: �}pNn Uti <br /> CST Name (Please Print) Signature Telephone No. <br /> T�141441ZQ h6ywlS <br /> Addre s Date CST Number <br />