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Wisconsin Department of Commerce SOIL AND SITE EVALUATION3 <br /> Divlsi6n of Safety and Buildings Page of <br /> Bureau of Integrated Services in accordance with Comm 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 6 V r ^3 e�� <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. Parcel I.D.# <br /> oz8 4116 63 9/S' <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)). <br /> Property Owner Property Location <br /> a, ) I (',v 'e Govt.Lot N W 1/4 SG 1/4,S / T N,R E(or)@ <br /> Property Owner's Mailing Address Lot# Block# Subd.Name or CSM# <br /> /oL,/q C,�rsov Rd �-FcR Sb� 5 <br /> City State Zip Code Phone Number <br /> ❑ City [__1 Village ® Town Nearest Road <br /> ooaer I W1 I S R3 (7is )63S-7.2s v�- + <br /> New Construction Use: (Residential/Number of bedrooms 3 Addition to existing building <br /> ❑ Replacement ❑Public or commercial-Describe: <br /> Code derived daily flow sd gpd Recommended design loading rate .7 bed,gpd/R2_'_�_trench,gpd/ft2 <br /> Absorption area required gibed,ft2 trench,ft2 Maximum design loading rate . t� bed,gpd/ft2 . (- trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s) 0(o GIV-8 S1144SCC--C-- ft(as referred to site plan benchmark) <br /> Additional design/site considerations fn� <br /> Parent material G I k C r C-i ( 1 ) Flood plain elevation,if applicable ft <br /> S = Suitable for system I Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank <br /> U = Unsuitable for systeml ❑ S V1 U Us ❑ U ® S ❑ U 9S ❑ U ❑S ® U ❑S ® U <br /> SOIL DESCRIPTION REPORT <br /> Boring# Horizon Depth Dominant Color Mottles Structure GPD/ft2 <br /> Texture Consistence Boundary Roots <br /> x in. Munsell Qu.Sz.Cont.Color Gr. <br /> lSz.Sh. /� Bed , Trench <br /> 2 <br /> 6-y8 7-S r V4 5 o s M I C Li 7 <br /> Ground <br /> elev. <br /> ft. <br /> Depth to <br /> limiting <br /> factor <br /> '4111 in. <br /> Remarks: <br /> Boring# <br /> I o-G r Y2 S SyK ✓�r C(.J 2 7 <br /> 3 M G 7 s' r S6 CziD s r 4 6S a S <br /> Ground <br /> elev. <br /> 0-7 <br /> Depth to <br /> limiting <br /> factor <br /> 43--in. Remarks: <br /> CST Name (Please Print) atu Telephone No. <br /> Address Date CST Number <br /> LA0 . Y 63 R 4 LOD 2 2 3 771 <br />