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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 <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. PaTcel I.D.# <br /> 03 2- 522G 03 300 <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)). [ C/ [' v 9*—7— <br /> Property Owner Property Location <br /> WILLIAM :�_AWJEX Govt.Lot? 1/4 1/4,S 2C. T41 ,N,R 15 E(or)(0 <br /> Property Owner's Mailing Address Lot# Block# Subd.Name or CSM# <br /> VOL - 4 <br /> City ❑ City State Zip Code Phone Number / Nearest Road <br /> A{�f155119 MN (65I )SIS-7/Wp 50 65Village ® Town <br /> ❑ New Construction Use: ❑Residential/Number of bedrooms Addition to existing building <br /> ❑ Replacement ❑Public or commercial-Describe: '' ..,, <br /> Code derived daily flow�gpd Recommended design loading rate AAL—bed,gpd/ft2 trench,gpd/ft2 <br /> Absorption area required NA bed,ft2Q?trench,ft2 Maximum design loading rate bed,gpd/ft2 trench,gpd/ft2 <br /> _116Recommended infiltration surface elevation(s) 17-75 ft(as referred to site plan benchmark) <br /> Additional design/site considerations 1 _ OQ/IJ <br /> Parent material 4kAuA�Fr Flood plain elevation,if applicable A 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 ❑S ❑ U ❑ S ❑ U I ❑S ❑ U ❑ S ❑ U ❑ S ❑ U <br /> SOIL DESCRIPTION REPORT <br /> Boris # Horizon Depth Dominant Color Mottles Structure GPD/ft2 <br /> Boring Texture Consistence Boundary Roots <br /> in. Munsell Du.Sz.Cont.Color Gr.Sz.Sh. Bed , Trench <br /> 1 I 0-3 S IZ Z �� MS S <br /> 2 -sl 7.5 4 4/1, '--- Ms . 7 .8 <br /> Ground 3 SIMI 5 a 414 �— MS . 7 •$ <br /> elev. <br /> �ODDft. 4 �8-11J 4 ` hs 7 •8 <br /> Depth to <br /> limiting <br /> f �r <br /> in. t I <br /> � <br /> Remarks: 44 atay <br /> Boring # <br /> Ground <br /> elev. <br /> n. <br /> Depth to <br /> limiting <br /> factor <br /> in. Remarks: <br /> CST Name (Please Print) Signature Telephone No. <br /> I�►+ARo lurl5 ,r.Gt,wtd IS- s(6- 4KI <br /> Add ss Date CST Number <br /> Z-1 -7(oo 14w 3�; vjgmlEK W 1 . 54g9s .5- - 99 5g <br />