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11}7isconsin'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. Parcel I.D.# <br /> © n?Sae/ c) �0 <br /> APPLICANT INFORMATION - Please print all information. Reviewed by / Date <br /> — <br /> Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). `/ <br /> Property Owner Property Location Pv <br /> Govt.Lot Fj 1/4 1/4,Sjy T3k ,N,R f, E(or)( <br /> Property Owner's Mailing Address Lot# Block# Subd.Name or CSM# <br /> 3 5 a ZJ, 5 kY/;.v e 4 <br /> City State Zip Code Phone Number ❑ CityVi lage Town Nearest Road r <br /> ❑ New Construction Use: C&esidential/Number of bedrooms Addition to existing building <br /> Replacement ❑Public or commercial-Describe: I r3 <br /> Code derived daily flow�00 gpd Recommended design loading rate + e bed,gpd/ft2 .6 trench,gpd/ft2 <br /> Absorption area required vPk9 bed,ft2-3Z- trench,it 2 Maximum design loading rate gybed,gpd/fl2 09 trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s) �6. oZ It(as referred to site plan benchmark) <br /> Additional design/site considerations <br /> Parent material (3114C.4/1= d 6�11R� Flood plain elevation,if applicable RJA ft <br /> S = Suitable for system I <br /> Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank <br /> U = Unsuitable for systemi 19..S ❑ u A ❑ u (mss ❑ U Ks ❑ u RU ❑ U ❑ S IS u <br /> SOIL DESCRIPTION REPORT <br /> Boring# Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2 <br /> in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. Bed , Trench <br /> fj ,2:) YY��' , .� <br /> Ground �6 7's /s S C� <br /> e�lpev. <br /> `Lpiift. <br /> Depth to <br /> limiting <br /> factor <br /> Remarks: <br /> Boring # <br /> 7.SYS s/` _/s 5 311-za , <br /> Ground <br /> elev. <br /> Depth to S <br /> limiting <br /> factor <br /> __Mln. Remarks: <br /> CST Name (Please Print) Signature Telephone No. <br /> C_>7Y9-;�8G <br /> Address Date CST Number <br /> Bo,ic's/ -5 45--,c2 — —'Z5_-F3 <br />