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Wisconsin Department of Commerce SOIL AND SITE EVALUATION <br /> Division of Safety and Buildings page of <br /> Bureau cA 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 /> APPLICANT INFORMATION- Please print all information. Reviewed Date <br /> ,;?;t O 7 <br /> Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). <br /> Properly Owner Property Location << <br /> TV �,/ Govt.Lot — 1/4/YE1/4,S T F ,N,R S Mer)W <br /> Property Owner's Mailin Address Lot# Block# Subd.Name or CSM# <br /> — <br /> Cr / ',�'` State Zip Code Phone Number <br /> ❑ <br /> G sift h // SSC � ( � ❑ City Village ,{� Town Nearest Road <br /> n� /S LLe 11W-Ifo <br /> D4 New Construction Use: Residential/Number of bedrooms _ Addition to existing building <br /> ❑ Replacement ❑Public or commercial-Describe: <br /> Code derived daily flow O gpd Recommended design loading rate bed,gpd/ft2 11 trench,gpd/ft2 <br /> Absorption area requiredI1104 3 ft2 trench,it Maximum design loading rate f7bad,gpd/ft2trench,gpd/ft2 <br /> Recommended infiltration surface elevation3 ft(as referred to site plan benchmark1 <br /> Additional design/site considerations /4 �� -eOf ICA 0,9,y/ <br /> r <br /> Parent material Flood plain elevation,if applicable ft <br /> S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank <br /> U = Unsuitable for systemi s ❑ u ❑s OU ElS 9 u <br /> SOIL DESCRIPTION REPORT <br /> Boring# Horizon Depth Dominant Color Mottles Structure GPD/ft2 <br /> in. Munsell Qu.Sz.Cont.Color Texture Gr.Sz.Sh. Consistence Boundary Roots <br /> Bed , Trench <br /> Ground 7Sy� �� RIM , l/` <br /> elev. <br /> g_2!!—ft. ; <br /> Depth to <br /> limiting <br /> factor <br /> Remarks: <br /> Boring# <br /> 4# t772 <br /> 7s 3Ground S — <br /> -elev. r <br /> ft. S <br /> 2 <br /> Depth to <br /> limiting <br /> tfa or , <br /> in. Remarks: r-rr��� <br /> CST Name (Please Print) KEN SCHMITZ I -Signature : Telephone No. <br /> MPRS•3077, CST1158 <br /> 2292r, Schmitz I aria X <br /> Address SHELL LAKE, W1 54871 ate CST Number <br /> (715) 458.2434 <br />