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Wiscongin 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. parcel I.D.# ,� <br /> 41al' *6 7-4�? 3L56 <br /> APPLICANT INFORMATION - Please print all information. Reviewed Date <br /> Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). fit ' <br /> Property Owner / 1 Property Location <br /> Ue_ 4 O l�I �N r Govt.Lot — 1/4— 1/4,S 7 T Vey ,N,R 15 E(or <br /> Property Owner's Mailing Address Lot# Block# 9abd- m <br /> Nae or CSM# <br /> *e_ LAI<r, nch — s <br /> CityState Zip Code Phone Numberrest Road <br /> 7� ❑ Ci� El Village Town Ksolj3 Nearest <br /> [WNew Construction Use: Residential/Number of bedrooms , Addition to existing building <br /> ❑ Replacement ❑Public or commercial-Describe: <br /> 'Ob derived daily flower gpd Recommended design loading rate .6 bed,gpd/ft2+Jtrench, <br /> trench,gpd/ft2 <br /> Absorption area required gibed,ft2.s�.3 trench,ft2 Maximum design loading rate d/ft2 <br /> g g bed,gpd/ft2gp <br /> Recommended infiltration surface elevation(s) 9S, ft(as referred to site plan benchmark) <br /> Additional design/site considerations <br /> Parent material CT/s>rz&/ d rif Flood plain elevation,if applicable.AZA _ft <br /> S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding NU U = unsuitable for system XS ❑ U P� 4 ❑ U �.S El MS EJU J S ❑ U ❑S ICI U <br /> SOIL DESCRIPTION REPORT <br /> Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2 <br /> in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. Bed , Trench <br /> ,7 A — cs <br /> Depth to <br /> limiting <br /> factor <br /> >ZY in. <br /> Remarks: <br /> Boring# <br /> SZMdk <br /> �al7P ZA 76 7,f<a <br /> 7,512>i <br /> Ground <br /> I� <br /> Depth to <br /> limiting <br /> factor <br /> >,2!Cin. Remarks: <br /> CST Name (Please Print) Signature Telephone No. <br /> A) S� o 07iKF-7A ?' <br /> Address Date CST Number <br /> Z?e,< .3583 <br />