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Wisconsin Department 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 81/2 x 11 inches in size. Plan must County 2 <br /> include,but not limited to: vertical and horizontal reference point(BM),direction and �G o3 SoCato�U(J a <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. arc <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 q� <br /> Sfl � WllLARD Govt.Lot 3 1/4 1/4,S ;Z4, 4 <br /> (o T 1li ,N,R E(or6_ <br /> Property Owner's Mailing Address Lot# Block# Subd.Name or CSM# <br /> ozo ALOE WIL.914i q& t V. 141 <br /> City State Zip Code Phone Number ❑ City ❑ Village Town Nearest Road <br /> c��z �Sss-oo41 sW�ss LutJ M tZ. <br /> )CNew Construction Use: residential/Number of bedrooms — Addition to existirigIbuilding <br /> El Replacement Public or commercial-Describe: <br /> Code derived daily flow <br /> 1 _gpd Recommended design loading rate bed,gpd/ft2-trench,gpd/ft2 <br /> Absorption area required �n`t3 bed,ftz5605 tren ,ft2,/ Maximum design loading rate '-� bed,gpd/f _ trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s) - �_�lA 9j•g ft(as referred to-sit2 plan benchmark) <br /> Additional design/site <br /> 11 considerations <br /> / <br /> Parent material���iL. Mer Flood plain elevation,if applicable MR ft <br /> S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank <br /> U = Unsuitable for system S ❑ U Dos El S El S ❑ U S ElU ❑S U <br /> SOIL DESCRIPTION REPORT <br /> Boris # Horizon Depth Dominant Color Mottles Structure GPD/ft2 ' <br /> Boring in. Munsell Qu.Sz.Cont.Color Texture Gr.Sz.Sh. Consistence Boundary Roots Bed Trench <br /> ilm x <br /> 5'-<AVFs All: itt/ S co <br /> Ground 3• 7_<0 ^- <br /> elev. ' <br /> Depth to <br /> limiting <br /> f r <br /> in. <br /> Remarks: <br /> Boring # <br /> AF <br /> 2 2 / •SItIR 4 HA ^-- 0off Af . 7 .8 <br /> Ground <br /> �31.KIft. <br /> Depth to <br /> limiting �C <br /> f ctor <br /> in. Remarks: <br /> CSrime (Please Print) Signature Telephone No. <br /> �4.4Ro P� - 6- 5 <br /> Address Date CST Number <br /> 217 6 0 36 1�•t . 5 z-- z -106 <br />