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Wisconsin Department of Commerce SOIL AND SITE EVALUATION <br /> Division of Safety and Buildings Page of <br /> Bur'eau of Integrated Services in accordance with s. ILHR 83.09, Wis. Adm. Code <br /> Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must County <br /> include,but not limited to: vertical and horizontal reference point(BM),direction and 4p Gl t <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. parcel I.D.# <br /> 02-0 q2Z5 01 0Q <br /> APPLICANT INFORMATION - Please print all information. Reviewed by Date <br /> r <br /> Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). 6a _Q/I <br /> Property Owner -r-� Property Location WW /7 <br /> D� Mo t 1 Govt.Lot 1/4 1/4,S 3Z T 40 ,N,R !6 E(oe <br /> Property Owner's Mailing Address Lot# Block# Subd.Name or CSM# <br /> 2j06. wt. 5"C: �1 . APT- 3oZ :5 AFRI ES ES`rAms <br /> City State Zip Code Phone Numberg IM Town N aresoa <br /> ❑ City ❑ Villa e t Rd <br /> U 1 I-S401(oldIS231-01fa I OA K L814 <br /> 4 New Construction Use: 0 Residential/Number of bedrooms Addition to existing building <br /> ❑.Replacement -z ❑Public or commercial-Describe: <br /> Code derived daily flow G1 3`gpd ,, Recommended design loading rate bed,gpd/ft2 -$ trench,gpd/ft2 <br /> Z. <br /> Absorption area required Lbed,ft2tr ch,ft2 Maximum design loading rate 7 bed,gpd/fl -$ trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s) ft(as referred to site plan benchmark) <br /> Additional design/site considerations <br /> Parent material ALAciiRi P91 fT Flood plain elevation,if applicable YA ft1�. <br /> S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank <br /> U = Unsuitable for system 10 S ❑ U lel S ❑ U ®S ❑ U IRS ❑ U I ®S ❑ U I ❑ s 5Zu <br /> SOIL DESCRIPTION REPORT <br /> Boring# Horizon Depth Dominant Color Mottles Structure GPD/tt2 <br /> Texture Consistence Boundary Roots <br /> in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. Bed , Trench <br /> �� � ', 0-5 7• R32 rte- 3 OS d1 CS CO •� -� <br /> Ica 7 .8 <br /> Ground 3 1- ►2 $- 1_ MS os pA� M 7 <br /> aellev� <br /> Depth to <br /> limiting <br /> f t r <br /> Remarks: <br /> Boring# <br /> M5 <br /> m._ o- T it <br /> �Ground <br /> �D•-[ft. <br /> Depth to Vh I <br /> limiting <br /> fajgQr <br /> �Pnin. Remarks: <br /> CST Name (Please Print) Signature Telephone No. <br /> 1cill}A90 {-0FX1At5 'cC� c>f( 15 -866- 51 <br /> Ad ress Date CST Number <br /> 2-11(00 <br />