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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. Pa el I.D.# <br /> APPLICANT INFORMATION- Please print all information. Reviewed by - / Dat�e9 7� <br /> Personal information you provide may be used for secondary purposes-(Privacy Law,s.1504(1)(m)). <br /> Property Owner Property Location <br /> TI'1' Govt.Lot 1 1/4 1/4,S Z( T40 ,N,R I�p E(ora) <br /> Property Owner's Mailing Address Lot# Block# Subd.Name or CSM# <br /> 1+78q 1CQrlWAy <br /> - <br /> city State Zip Code Phone Numb r ❑ City ❑ Village Town Nearest Road <br /> >J19-5717-41 ( > 3S <br /> New Construction Use: residential/Number of bedrooms Addition to existing building <br /> Replacement ❑Public or commercial-Describe: <br /> Code derived daily flow 3va gpd Recommended design loading rate -07 bed,gpd/ft2—.$---trench,gpd/ft2 <br /> Absorption area required_ jVQ bed,ft2 3*7-T trench,ft2 Maximum design loading rate 2 7 bed,gpd/ft2�_trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s) 71 3 it(as referred to site plan benchmark) <br /> Additional design/site considerations <br /> Parent material GLACIA .. 3RIOT Flood plain elevation,if applicable N ft <br /> S Suitable for system Conventional MoundIn-Ground Pressure I AT-Grade System in Fill Holding Tank <br /> U = Unsuitable for system S u I XS ❑ UMS ❑ u INS ❑ U NS ❑ u I ❑S NU <br /> SOIL DESCRIPTION REPORT <br /> Boring# Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/112 <br /> in. Munsell Cu.Sz.Cont.Color Gr.Sz.Sh. Bed , Trench <br /> 1 I 0.5 7 R <br /> Z- 47. ,!• fr-- IkS OAS INI ,'•_ co . 7 •IS <br /> Ground <br /> CPev <br /> CP ft. <br /> Depth to <br /> limiting <br /> fafftQ�(r <br /> Remarks: <br /> Boring# <br /> ' 0 MUS 05 'µ1 S co 1 ,$ <br /> z 4 /� co .I .8 <br /> Ground <br /> ev. <br /> ,Zft. <br /> Depth to <br /> limiting <br /> factor <br /> y in. Remarks: <br /> CST Name (Please Print) Signature Telephone No. <br /> c"Aiw 146PKAS <br /> Add ss Date CST Number <br /> Z`i"1loo Nw 35 LJf:6.srtl2 W 1. 54893 -Z9 - Zz58sI <br />