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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 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 31W rA-1&_ <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. Parcel I.D.# <br /> a/6 - o/ - s© 1) <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 <br /> J}In es 4 /.e,,jZ c_A Govt. Lot y 1/4 1/4,S16 T�/o ,N,R /:5— E(or)Z/ <br /> Property Owner's Mailing Address Lot If Block# Subd.Name or CSM# <br /> 8 g:!5-_ Co, c -- - <br /> City State Zip Code Phone Numbero <br /> ❑ City ❑ Village 0 Town Nearest Rd <br /> I-JT 15,V070 ( ).W5?-3;2.9'6j .TRC lrs o.LJ <br /> ❑ New Construction Use: Residential/Number of bedrooms Addition to existing building ~ <br /> aReplacement '` ❑Public or commercial-Describe: <br /> Code derived daily flow �So gpd Recommended design loading rate --3 bed,gpd/n2 i trench,gpd/ft2 <br /> Absorption area required 9'6D bed,ft2 /_'!�o trench,ft2 Maximum design loading rate . bed,gpd/ft2 416trench,gpd/ft2 <br /> O <br /> Recommended infiltration surface elevation(s) /6"oZ ft(as referred to site plan benchmark) <br /> Additional design/site considerations <br /> Parent material CT. ,eq t/r Flood plain elevation,if applicable eZ.,1A It <br /> S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank <br /> U = Unsuitable for system S ❑ U 2!�s ❑ U 2.s ❑ U 1 Lis ❑ U 19S ❑ U ❑ S 19 U <br /> SOIL DESCRIPTION REPORT <br /> Boring# Horizon Depth Dominant Color Mottles Structure GPD/ft2 <br /> Texture Consistence BoundaryLRootsin. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. Bed , Trench <br /> 6k �J c S ad .7 <br /> 7,sce S� <br /> Glev round z Sy/P �' f S I <br /> 7S %,r K� lza,sol/F <br /> Depth to <br /> limiting <br /> fa tt <br /> in. <br /> Remarks: <br /> Boring # <br /> �,s .P-ka k <br /> a <br /> _J V0 7,5,; ;'e ,6"', 6 <br /> ,6 7, s' -- k ,- 3a <br /> Ground >�J� 7i /e S Cao�S S S� <br /> lev <br /> Depth to <br /> limiting <br /> factor <br /> 4-7—in. Remarks: <br /> CST Name (Please Print) Signature Telephone No. <br /> Address Date CST Number <br />