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Wisconsin Department of Commerce SOIL AND SITE EVALUATION <br /> Division of Safety and Buildings Page 4 of <br /> Bureau of Integrated Services in accordance with Comm 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 <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. <br /> ��?� parcel I.D.# <br /> a <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)). �tL7 �/� <br /> Property Owner Property Location W <br /> Govt.Lot 1/4/Y4,-1/4,S �2, T:Tq ,N,R//S fir)W <br /> Property Owner's Mailing Address �� Lot# Block# Subd.Name or CSM# <br /> City State Zip Code Phone Number ❑ City Q Village Town Nearest Road <br /> AiH f�E /$c P4 1 (0 )v?S-X72, <br /> New Construction Use: Residential/Number of bedrooms Addition to existing building <br /> Replacement Public or commercial-Describe: <br /> Code derived daily flow 1'5'0 gpd Recommended design loading rate V-7_bed,gpd/fl2 _e�trench,gpd/ft2 <br /> Absorption area required 6`A 3 bed,ft2 57W 3' It Maximum design loading rate bed, d/ft2 r <br /> �J D �y� g g �_ gp trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s) 1- 06N 7//. ��°�B �i(� ft(as referred to site plan benchmark) <br /> Additional design/site considerations <br /> rv ft <br /> Parent material Flood plain elevation,if applicable <br /> S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank <br /> U Unsuitable for system XS El U ElS U f�S ❑ U ❑ S A U ❑S PZ U ❑ S U <br /> SOIL DESCRIPTION REPORT <br /> Boring# Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2 <br /> Vy in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. Bed Trench <br /> ( 5 e& <br /> Ground <br /> 9 elev r <br /> ft. <br /> Depth to <br /> limiting ; <br /> factor <br /> Remarks: <br /> Boring# c/ <br /> y <br /> f <br /> >-m <br /> Ground �71�( <br /> �el <br /> Depth to <br /> limiting <br /> factor q <br /> gWin. Remarks: A <br /> CST Name (Please Print) KLN SIGHM114 ING. Sig re Telephone No. <br /> Septic Systems <br /> MPRS/CST 224173 <br /> Address Date CST Number <br /> SHELL LAKE,WI 54871 <br />