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Wisconsin Department of Commerce SOIL AND SITE EVALUATION <br /> Division of Safety and Buildings Page_of <br /> Bureau gf integraw Services in accordance with s. ILHR 83.09,Wis.Adm. Code <br /> Attach complete site plan on paper not less than B 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 /> 0 3 6y '?Oe) <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)). SL <br /> Property Owner Property Location G ( J Q <br /> R N S7r Govt.Lot 1/4 1/4,S 7 T40 ,N,R 14 E(or)I y� <br /> Property er's Mailing Address Lot# I Block# Subd.Name or CSM# <br /> -"S ► '9 5P9104 9604 ADD. Ta, V V. <br /> City State Zip Code Phone Number ❑ Ci ❑ Village ® Town Nearest Road <br /> 1ZOoKL IJ. SS444 ( �Iz )546- 247 SCO R. WA <br /> New Construction Use: Residential/Number of bedrooms Addition to existing building <br /> Replacement ❑Public or commercial-Describe: <br /> Code detived daily flow IM gpd Recommended design loading rate .7 bad,gpd/fl2 ,$ trench,gpdMtz <br /> Absorption area required bed,ft2 3 pL? trench,ft2 Maximum design loading rate •� bed,gpd* _S trench,gpd* <br /> Recommended Infiltration surface elevation(s) U.5 ft(as referred to site plan benchmark) <br /> Additional design/siteeconsiderations <br /> Parent material G IALf ayg l y'r Flood plain elevation,if applicable NA ft <br /> S Suitable for system I Conventional Mound In-Ground Pressure AT-GradeSystem in Fill Holding Tank <br /> U Unsuitable for systeml Dos ❑ u ®s ❑ U ZS 0u I V1 S ❑ UT ®S ❑ u ❑s Y u <br /> SOIL DESCRIPTION REPORT <br /> Boring# Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/112in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. Bed ,Trench <br /> 13 1 0.1 7-5\4K 3 2 �- K6 D 4Y A5 Zj .7 ' . <br /> 2 1-&4 115 6er mvir ^- .7 <br /> Ground <br /> lev$ <br /> ft. <br /> Depth to <br /> limiting <br /> f ct r <br /> Remarks: <br /> Boring# <br /> 1 0- 9 317— - Ms 7 8 <br /> 2 2 7-641 7 S R 4 /'--- Ms -7 <br /> 3 <br /> 46-701 C2ds ese Ms -7 g <br /> Ground <br /> elev. <br /> k y , <br /> Depth to <br /> limiting <br /> ftgor in Remarks: AM4& $o l2oJ 4 <br /> CST Name (Please Print) Si a Telephone No. <br /> �HAaD OMW3 7i5- 266- 4-4-57 <br /> Address Date CST Number <br /> Z110 Hn 35 W60MIz W1- 54893 3- 31- g$ 3670 <br />