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e <br /> Wisconsin Department of Commerce SOIL AND SITE EVALUATION <br /> Division of Safety and Buildings Page of <br /> Bureau of Irtegrated 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 SURAIKTr <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. Pa cel I.D.# <br /> 6 -off- <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 /> E Govt.Lot 1/4 1/4,S % T N,R 5 E(or W <br /> Property Owner's Mailing Address Lot# Block# Subd.Name or CSM# <br /> ZS63(o 31RID 6 RD. 1 C,Sm W,02- pq, <br /> City State Zip Code Phone Number ❑ City ❑ Village 19 Town Ne rest Road <br /> WI 164930 1 ( IS X54-3244 KID <br /> ❑ New Construction Use: 19 Residential/Number of bedrooms Addition to existing building <br /> NReplacement ❑Public or commercial-Describe: <br /> Code derived daily flowgpd Recommended design loading rate bed,gpd/fez .% trench,gpd/ft2 <br /> Absorption area required bed,ft25LS rench,ft Maximum design loading rate .7 bed,gpd/fl2 .S trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s) n.1 ft(as referred to site plan benchmark) <br /> Additional design/sitle�considerations <br /> it <br /> Parent material�CjAL A iR7 Flood plain elevation,if applicable NA n <br /> S = Suitable for system Conventional �cM�tound In-Ground Pressure AT-Grade System in Fill Holding Tank <br /> U = Unsuitable for system S ❑ U u4 s ❑ u1A S ❑ u LOS ❑ u I] s ❑ u ❑s 1Xu <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 Bed Trench <br /> l D•5 �. 2 �--- ifs osall f <o .8 <br /> 7— ' �� /tf5 /btl hn . 7 •S <br /> Ground <br /> IeNL <br /> n. ' <br /> Depth to <br /> limiting <br /> far <br /> Tin. <br /> Remarks: <br /> Boring# •,t .$ <br /> f`— Mj <br /> .� <br /> � <br /> 2- 5- o •.S ��� Hs . .8 <br /> Ground <br /> lev. <br /> n. <br /> Depth to <br /> limiting <br /> factor 3a Rt PJ <br /> in. Remarks: gAf�`" "••tee» 6 <br /> CST Name (Please Print) Signature Telephone No. <br /> 44A90 14vPg14x Alz1W 1S-S66- X157 <br /> Address Date CST Number <br /> Z?T fl 'ss h��Bsn=�e W 1. 54$9 3 <br /> _14- % 9-7-51571 <br />