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W'sconsin Department of Commerce SOIL AND SITE EVALUATION <br /> Division of Safety and Buildings Page of <br /> BuFeau'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 V 8146 <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. Parcel I.D.# <br /> 5bo <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 /> O� Govt.Lot 1/4 1/4,S 23 T Lb ,N,R 15 E(o& <br /> Property Owner's Mailing Address Lot# Block# Subd.Name or CSM# <br /> City State Zip Code Phone Number <br /> ❑ City E:1 Village K Town Nearest Road <br /> MO55� 5434 ((e Q- > 90- i ::YACKSO4 614-A�1D <br /> yu <br /> ❑ New Construction Use: Residential/Number of bedrooms 2 Addition to existing building <br /> 9 Replacement ❑Public or commercial-Describe: <br /> Code derived daily flow gpd Recommended design loading rate bed,gpd/ft2 $ trench,gpd/ft2 <br /> Absorption area required 1--[]1 bed,ft2 3�S trench,ft2 Maximum design loading rate bed,gpd/ft2 .S trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s) 2• It(as referred to site plan benchmark) <br /> Additional design/site considerations <br /> Parent material GLAC101flL 1C)P j fr Flood plain elevation,if applicable NA ft <br /> S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank <br /> U = unsuitable for systeml 54S ❑ U MS ❑ U ® S ❑ u Rs ❑ U ®S ❑ U ❑ s RU <br /> SOIL DESCRIPTION REPORT <br /> Boris # Horizon Depth Dominant Color Mottles Structure GPD/ft2 <br /> 9 Texture Consistence Boundary Roots <br /> ---_------: in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. Bed , Trench <br /> t 0.5 x yrs ► Cs 7 8 <br /> Ground 3Z.M 7 4 A <br /> �tS <br /> �e�lev� <br /> Depth to <br /> limiting <br /> factor <br /> n. <br /> Remarks: <br /> Boring# <br /> 1CL 6 7S 110 . 7 8 <br /> Z o 7SX4 (e �-- ,►rs 7 $ <br /> Ground <br /> tuft• <br /> Depth to <br /> limiting <br /> fafor ,1 <br /> in. Remarks: T' <br /> ST Name (Please Print) Signature Telephone No. <br /> 91c4qR0 1-kPg114.5 1 S. W_ g .S <br /> Add ss Date CST Number <br /> 2iZ(Do Awq 3-5 Lel• _54V-3;.3 5.76- q 2S <br />